| Name: | Dr. Ritky C. Dy Medical Clinic, L.L.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 24 Jan 2000 (25 years ago) |
| Entity Number: | 000-668-135 |
| Register Number: | 000668135 |
| County: | Chilton |
| Place of Formation: | Chilton County |
| Registered Office Street Address: | 1221 7TH ST SOUTHCLANTON, AL 35045 |
| Registered Office Street Address ZIP Code: | 35045 |
| Principal Address: | CLANTON, AL |
Activities
RENDER PROFESSIONAL MEDICAL SERVICES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1083758338 | 2007-02-19 | 2022-02-22 | PO BOX 109, CLANTON, AL, 350460109, US | 1221 7TH ST S, CLANTON, AL, 350453723, US | |||||||||||||||||||||||||
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| Phone | +1 205-280-6789 |
| Fax | 2052801350 |
Authorized person
| Name | DR. RITKY C DY |
| Role | OWNER |
| Phone | 2052806789 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | 18537 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 000093998 |
| State | AL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DR RITKY C DY MEDICAL CLINIC L 401 K PROFIT SHARING PLAN TRUST | 2010 | 631242852 | 2011-07-25 | DR RITKY C. DY MEDICAL CLINIC, | 8 | |||||||||||||||||||||||||||||
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| Administrator’s EIN | 631242852 |
| Plan administrator’s name | DR RITKY C. DY MEDICAL CLINIC, |
| Plan administrator’s address | 1221 7TH ST SOUTH, CLANTON, AL, 35045 |
| Administrator’s telephone number | 2052806789 |
Signature of
| Role | Plan administrator |
| Date | 2011-07-25 |
| Name of individual signing | DR RITKY C. DY MEDICAL CLINIC, |
| Name | Role |
|---|---|
| DY, RITKY C | Agent |
| Name | Role |
|---|---|
| DY, RITKY C | Member |
Date of last update: 15 Aug 2024
Sources: Alabama Secretary of State
