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Mizell Memorial Hospital Incorporated

Details

Name: Mizell Memorial Hospital Incorporated
Jurisdiction: Alabama
Legal type: Domestic Non-Profit Corporation
Status: Exists
Date of registration: 26 Nov 1945 (79 years ago)
Entity Number: 000-817-161
Register Number: 000817161
County: Covington
Place of Formation: Covington County
Registered Office Street Address: 702 N MAIN STOPP, AL 36467
Registered Office Street Address ZIP Code: 36467
Registered Office Mailing Address: PO BOX 1010OPP, AL 36467
Registered Office Mailing Address ZIP Code: 36467
Principal Address: OPP, AL 36467
Principal Address ZIP Code: 36467

Activities OPERATE HOSPITAL

Unique Entity ID

Unique Entity ID Expiration Date Physical Address Mailing Address
H6P9LZQM7RP5 2025-03-26 702 N MAIN ST, OPP, AL, 36467, 1626, USA P O BOX 1010, OPP, AL, 36467, 1010, USA

Business Information

URL www.mizellmh.com
Congressional District 02
State/Country of Incorporation AL, USA
Activation Date 2024-04-01
Initial Registration Date 2010-07-30
Entity Start Date 1945-11-26
Fiscal Year End Close Date Sep 30

Service Classifications

NAICS Codes 622110

Points of Contacts

Electronic Business
Title PRIMARY POC
Name JANA WYATT
Role CFO
Address P.O. BOX 1010, 702 N. MAIN STREET, OPP, AL, 36467, 1010, USA
Government Business
Title PRIMARY POC
Name JANA WYATT
Role CFO
Address P.O. BOX 1010, 702 N. MAIN STREET, OPP, AL, 36467, 1010, USA
Past Performance Information not Available

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1710749981 2024-01-24 2024-03-26 PO BOX 1010, OPP, AL, 364671010, US 702 N MAIN ST STE 2, OPP, AL, 364671626, US

Contacts

Phone +1 334-493-5704
Fax 3344939664

Authorized person

Name JANA WYATT
Role CFO
Phone 3344935790

Taxonomy

Taxonomy Code 207Q00000X - Family Medicine Physician
Is Primary No
Taxonomy Code 261QC1500X - Community Health Clinic/Center
Is Primary No
Taxonomy Code 261QU0200X - Urgent Care Clinic/Center
Is Primary Yes

Commercial and government entity program

CAGE number Status Type Established CAGE Update Date CAGE Expiration SAM Expiration
631R9 Active Non-Manufacturer 2010-08-02 2024-04-01 2029-04-01 2025-03-26

Contact Information

POC JANA WYATT
Phone +1 334-493-5790
Fax +1 334-493-3789
Address 702 N MAIN ST, OPP, COVINGTON, AL, 36467 1626, UNITED STATES

Ownership of Offeror Information

Highest Level Owner Information not Available
Immediate Level Owner Information not Available
List of Offerors (0) Information not Available

Agent

Name Role
WYATT, JANA Agent

Incorporator

Name Role
LOYON, F M Incorporator
FOSTER, J C JR Incorporator
DANLEY, H D Incorporator
MACLENNON, E R Incorporator
WATERS, H W SR Incorporator
HURST, J C Incorporator
PIERCE, G C Incorporator
JEFFCOAT, R S Incorporator
CHANNELL, J L SR Incorporator

Date of last update: 16 Aug 2024

Sources: Alabama Secretary of State