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 |
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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