| Name: | North Mississippi Medical Clinics, Inc. |
| Jurisdiction: | Alabama |
| Legal type: | Foreign Non-Profit Corporation |
| Status: | Exists |
| Date of registration: | 18 May 1990 (35 years ago) |
| Entity Number: | 000-896-695 |
| Register Number: | 000896695 |
| Historical Names: |
North Mississippi Family Medical Clinics, Inc.
|
| ZIP code: | 36104 |
| County: | Montgomery |
| Place of Formation: | Delaware |
| Principal Address: | 1209 ORANGE STREETWILMINGTON, DE 19801 |
| Registered Office Street Address: | 2 NORTH JACKSON ST., SUITE 605MONTGOMERY, AL 36104 |
Activities
OPERATE MEDICAL CLINIC
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1285739680 | 2006-09-13 | 2020-08-22 | 450 E PRESIDENT AVE, TUPELO, MS, 388015599, US | 1200 MILITARY STREET SOUTH, HAMILTON, AL, 35570, US | |||||||||||||||||||||||||
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| Phone | +1 662-377-4685 |
| Fax | 6623772755 |
| Phone | +1 205-952-9824 |
| Fax | 2059529815 |
Authorized person
| Name | GERALD KIMBROUGH |
| Role | MANAGER |
| Phone | 6623774685 |
Taxonomy
| Taxonomy Code | 208000000X - Pediatrics Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 09015454 |
| State | MS |
| Name | Role | Address |
|---|---|---|
| C T CORPORATION SYSTEM | Agent | 2 NORHT JACKSON STREET SUITE 605MONTGOMERY, AL 36104 |
| Event Date | Event Type | Old Value | New Value |
|---|---|---|---|
| 1998-10-01 | Name Change | North Mississippi Family Medical Clinics, Inc. | North Mississippi Medical Clinics, Inc. |
Date of last update: 16 Aug 2024
Sources: Alabama Secretary of State
