| Name: | Physicians Care of Sweet Water, L.L.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 12 Sep 2011 (13 years ago) (Companies founded in September 2011) |
| Entity Number: | 000-025-201 |
| Register Number: | 000025201 |
| ZIP code: | 36726 (Companies in Wilcox, 36726) |
| County: | Wilcox |
| Place of Formation: | Marengo County |
| Registered Office Street Address: | 24B CAMDEN BYPASSCAMDEN, AL 36726 |
Activities
MEDICAL FAMILY PRACTICE & RELATED SERVICES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1316223969 | 2011-10-27 | 2019-01-16 | 31431 ALABAMA HIGHWAY 10, SWEET WATER, AL, 367824936, US | 31431 ALABAMA HIGHWAY 10, SWEET WATER, AL, 367824936, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 334-636-5311 |
| Fax | 3346362280 |
Authorized person
| Name | HUEY R KIDD |
| Role | PHYSICIAN |
| Phone | 3346365311 |
Taxonomy
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| Is Primary | Yes |
| Taxonomy Code | 261QR1300X - Rural Health Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 313M00000X - Nursing Facility/Intermediate Care Facility |
| Is Primary | No |
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICARE PTAN |
| Number | 102G081345 |
| State | AL |
| Name | Role |
|---|---|
| PHYSICIANS CARE OF CLARKE | Agent |
| Name | Role | Address |
|---|---|---|
| KIDD, HUEY R | Member | 1145 TREVOR CIRCLETHOMASVILLE, AL 36784 |
| KIDD, CHARLES R | Member | 447 HIDEAWAY ROADCAMDEN, AL 36726 |
| Name | Role | Address |
|---|---|---|
| KIDD, HUEY R | Organizer | 1145 TREVOR CIRCLETHOMASVILLE, AL 36784 |
Date of last update: 30 Jul 2024
Sources: Alabama Secretary of State
