| Name: | Millry Pediatric Clinic, L.L.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 19 Aug 2011 (13 years ago) (Companies founded in August 2011) |
| Entity Number: | 000-023-250 |
| Register Number: | 000023250 |
| ZIP code: | 36558 (Companies in Washington, 36558) |
| County: | Washington |
| Place of Formation: | Washington County |
| Registered Office Street Address: | 75 FIFTH AVENUEMILLRY, AL 36558 |
Activities
MEDICAL CLINIC
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1316223027 | 2011-10-26 | 2022-12-20 | PO BOX 465, MILLRY, AL, 365580465, US | 73 LONG STREET, MILLRY, AL, 36558, US | |||||||||||||||||||||||||||||||||||
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| Phone | +1 251-846-3233 |
| Fax | 2518463224 |
Authorized person
| Name | JENNIFER L MCNEASE |
| Role | OWNER/PEDIATRIC NURSE PRACTITIONER |
| Phone | 2518463233 |
Taxonomy
| Taxonomy Code | 261QR1300X - Rural Health Clinic/Center |
| Is Primary | Yes |
| Taxonomy Code | 363L00000X - Nurse Practitioner |
| Is Primary | No |
| Taxonomy Code | 363LP2300X - Primary Care Nurse Practitioner |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 137591 |
| State | AL |
| Issuer | MEDICAID |
| Number | 136193 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| FLOORE, LEAH | Organizer | 8900 HEID PLACEMOBILE, AL 36695 |
| MCNEASE, JENNIFER | Organizer | 75 Fifth AvenueMillry, AL 36558 |
| Name | Role | Address |
|---|---|---|
| MCNEASE, JENNIFER | Agent | 75 Fifth AvenueMillry, AL 36558 |
| Name | Role | Address |
|---|---|---|
| MCNEASE, JENNIFER | Member | 75 Fifth AvenueMillry, AL 36558 |
| Brian McNease | Member | 75 Fifth AvenueMillry, AL 36558 |
Date of last update: 30 Jul 2024
Sources: Alabama Secretary of State
