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North Jefferson Internal Medicine, P.C.

Details

Name: North Jefferson Internal Medicine, P.C.
Jurisdiction: Alabama
Legal type: Domestic Professional Corporation
Status: Dissolved
Date of registration: 29 Aug 2000 (24 years ago)
Date of dissolution: 31 Dec 2015
Entity Number: 000-211-892
Register Number: 000211892
County: Jefferson
Place of Formation: Jefferson County
Principal Address: FULTONDALE, AL
Registered Office Street Address: 2619 DECATUR HIGHWAYFULTONDALE, AL 35068
Registered Office Street Address ZIP Code: 35068
Authorized Capital: $1,000

Activities SPECIALIZED IN THE PRACTICE OF INTERNAL MEDICINE

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1124139282 2006-08-31 2010-08-31 2619 DECATUR HWY, FULTONDALE, AL, 350681723, US 2619 DECATUR HWY, FULTONDALE, AL, 350681723, US

Contacts

Phone +1 205-841-9898
Fax 2058419880

Authorized person

Name DR. GREG HILL.
Role OWNER
Phone 2058419898

Taxonomy

Taxonomy Code 207R00000X - Internal Medicine Physician
Is Primary Yes

Other Provider Identifiers

Issuer MEDICAID
Number 529910230
State AL
Issuer MEDICARE PTAN
Number I635
State AL

Agent

Name Role
HILL, GREGORY GRIFFIN Agent

Incorporator

Name Role Address
SCHIFF, GARY S Incorporator 420 20TH STREET NORTH, SUITE 1400BIRMINGHAM, AL 35203

Date of last update: 01 Aug 2024

Sources: Alabama Secretary of State