| Name: | Black Belt Medical, Inc. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Corporation |
| Status: | Dissolved |
| Date of registration: | 03 Dec 2002 (22 years ago) |
| Date of dissolution: | 08 Jan 2009 |
| Entity Number: | 000-226-237 |
| Register Number: | 000226237 |
| ZIP code: | 36695 |
| County: | Mobile |
| Place of Formation: | Mobile County |
| Principal Address: | MOBILE, AL |
| Registered Office Street Address: | 7856 WESTSIDE PARK DR STE CMOBILE, AL 36695 |
| Authorized Capital: | 500 |
Activities
MANAGEMENT COMPANY FOR HEALTHCARE RELATED BUSINESS
| Type | Company Name | Company Number | State |
|---|---|---|---|
| Headquarter of | Black Belt Medical, Inc., MISSISSIPPI | 734238 | MISSISSIPPI |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1689632838 | 2006-05-03 | 2008-03-27 | 7856 WESTSIDE PARK DR, SUITE C, MOBILE, AL, 366958541, US | 1004 JEFF DAVIS AVE, SELMA, AL, 367014519, US | |||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||
| Phone | +1 251-633-8090 |
| Fax | 2516336941 |
| Phone | +1 334-872-9721 |
| Fax | 3348744923 |
Authorized person
| Name | JERRY CARL JR. |
| Role | CEO/PRESIDENT |
| Phone | 2516338090 |
Taxonomy
| Taxonomy Code | 332B00000X - Durable Medical Equipment & Medical Supplies |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | 51516028 |
| State | AL |
| Name | Role |
|---|---|
| LAMBERT, JAMES M | Agent |
| Name | Role |
|---|---|
| LAMBERT, JAMES M | Incorporator |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
