| Name: | Citrin Cardiology, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 21 Dec 2016 (8 years ago) |
| Entity Number: | 000-379-475 |
| Register Number: | 000379475 |
| County: | Mobile |
| Place of Formation: | Mobile County |
| Principal Address: | 91-A SOOST COURTMOBILE, AL 36608 |
| Principal Address ZIP Code: | 36608 |
| Authorized Capital: | 100@$1.00PV |
Activities
OPERATION AND MANAGEMENT OF CARDIOLOGY MEDICAL PRACTICE
| Unique Entity ID | Expiration Date | Physical Address | Mailing Address | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| N1ELH6DYA3M7 | 2024-11-06 | 6701 AIRPORT BLVD STE C138, MOBILE, AL, 36608, 3784, USA | 6701 AIRPORT BLVD STE C138, MOBILE, AL, 36608, 3784, USA | |||||||||||||||||||||||||||||||||||||||||
|
||||||||||||||||||||||||||||||||||||||||||||
| Congressional District | 01 |
| State/Country of Incorporation | AL, USA |
| Activation Date | 2023-11-09 |
| Initial Registration Date | 2018-11-06 |
| Entity Start Date | 2017-02-01 |
| Fiscal Year End Close Date | Dec 31 |
Service Classifications
| NAICS Codes | 621111 |
Points of Contacts
| Electronic Business | |
|---|---|
| Title | PRIMARY POC |
| Name | GEORGIA THOMAS |
| Role | BUSINESS MANAGER |
| Address | 6701 AIRPORT BLVD STE C138, MOBILE, AL, 36608, USA |
| Government Business | |
|---|---|
| Title | PRIMARY POC |
| Name | GEORGIA THOMAS |
| Role | BUSINESS MANAGER |
| Address | 6701 AIRPORT BLVD STE C138, MOBILE, AL, 36608, USA |
| Past Performance | Information not Available |
|---|
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1588109599 | 2016-12-29 | 2024-06-17 | 6701 AIRPORT BLVD, SUITE C138, MOBILE, AL, 366083784, US | 6701 AIRPORT BLVD, SUITE C138, MOBILE, AL, 366083784, US | |||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||
| Phone | +1 251-333-3333 |
| Fax | 2514104444 |
Authorized person
| Name | BEN S CITRIN |
| Role | OWNER / PRESIDENT |
| Phone | 2513333333 |
Taxonomy
| Taxonomy Code | 207RC0000X - Cardiovascular Disease Physician |
| License Number | 18816 |
| State | AL |
| Is Primary | No |
| Taxonomy Code | 207RI0011X - Interventional Cardiology Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 096069 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| CITRIN, ELIZABETH A | Agent | 28080 HIGHWAY 98 SUITE GDAPHNE, AL 36526 |
| Name | Role | Address |
|---|---|---|
| CITRIN, BENJAMIN S | Director | 91-A SOOST COURTMOBILE, AL 36608 |
| Name | Role | Address |
|---|---|---|
| CITRIN, BENJAMIN S | Incorporator | 91-A SOOST COURTMOBILE, AL 36608 |
Date of last update: 13 Aug 2024
Sources: Alabama Secretary of State
