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
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 | |||||||||||||||||||||||||||
|
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 |
Name | Role |
---|---|
HILL, GREGORY GRIFFIN | Agent |
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