| Name: | Active Orthopedic Bracing, Inc. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Corporation |
| Status: | Dissolved |
| Date of registration: | 26 May 2006 (19 years ago) |
| Date of dissolution: | 15 Feb 2018 |
| Entity Number: | 000-247-433 |
| Register Number: | 000247433 |
| Historical Names: |
Bama Orthotics Lab Inc.
|
| ZIP code: | 35811 |
| County: | Madison |
| Place of Formation: | Madison County |
| Registered Office Street Address: | 172 CHANEL DRHUNTSVILLE, AL 35811 |
| Principal Address: | HUNTSVILLE, AL |
| Authorized Capital: | 1,000 |
Activities
PRODUCE ORTHOTIC DEVICES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1548413073 | 2008-10-28 | 2013-01-08 | 2745 BOB WALLACE AVE SW, STE D, HUNTSVILLE, AL, 358054158, US | 2745 BOB WALLACE AVE SW, STE D, HUNTSVILLE, AL, 358054158, US | |||||||||||||||||||||||||
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| Phone | +1 256-534-8637 |
| Fax | 2567040024 |
Authorized person
| Name | JAMES THOMAS BUCHHOLZ |
| Role | ORTHOTIST/OWNER |
| Phone | 2565348637 |
Taxonomy
| Taxonomy Code | 332BC3200X - Customized Equipment (DME) |
| License Number | 6890 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1548413073 |
| State | AL |
| CAGE number | Status | Type | Established | CAGE Update Date | CAGE Expiration | SAM Expiration | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 5HSJ1 | Active | U.S./Canada Manufacturer | 2009-06-09 | 2021-08-03 | No data | No data | |||||||||||||||
|
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| POC | ALICE BUCHHOLZ BUCHHOLZ |
| Phone | +1 256-534-8637 |
| Fax | +1 256-704-0024 |
| Address | 2745 BOB WALLACE AVE SW STE D, HUNTSVILLE, AL, 35805 4177, 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 |
|---|
| Name | Role |
|---|---|
| FOURROUX, GEORGE JR | Agent |
| Name | Role |
|---|---|
| FOURROUX, GEORGE JR | Incorporator |
| Event Date | Event Type | Old Value | New Value |
|---|---|---|---|
| 2007-10-03 | Name Change | Bama Orthotics Lab Inc. | Active Orthopedic Bracing, Inc. |
| Contract Type | Award or IDV Flag | PIID | Start Date | Current End Date | Potential End Date | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| PO | AWARD | VA521O11707 | 2011-06-06 | 2011-06-06 | 2011-06-06 | |||||||||||||||||||||
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| Title | ORTHOTIC |
| NAICS Code | 423450: MEDICAL, DENTAL, AND HOSPITAL EQUIPMENT AND SUPPLIES MERCHANT WHOLESALERS |
| Product and Service Codes | 6545: MEDICAL SETS KITS & OUTFITS |
Recipient Details
| Recipient | ACTIVE ORTHOPEDIC BRACING, INC. |
| UEI | LMU1FTY2NBQ5 |
| Legacy DUNS | 825361574 |
| Recipient Address | UNITED STATES, 2745 BOB WALLACE AVE SW STE D, HUNTSVILLE, 358054177 |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
