Name: | Valley Family Physician Care, P.C. |
Jurisdiction: | Alabama |
Legal type: | Domestic Professional Corporation |
Status: | Exists |
Date of registration: | 28 Nov 2001 (23 years ago) |
Entity Number: | 000-219-891 |
Register Number: | 000219891 |
County: | Madison |
Place of Formation: | Madison County |
Principal Address: | HUNTSVILLE, AL |
Registered Office Street Address: | 4820 UNIVERSITY DR STE 35HUNTSVILLE, AL 35816 |
Registered Office Street Address ZIP Code: | 35816 |
Authorized Capital: | $10 |
Activities
MEDICAL SERVICES
NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1851444368 | 2007-01-19 | 2011-04-25 | 1868 SPARKMAN DR. NW, HUNTSVILLE, AL, 358161122, US | 1868 SPARKMAN DR. NW, HUNTSVILLE, AL, 358161122, US | |||||||||||||||||||||||||||||||
|
Phone | +1 256-721-9916 |
Fax | 2567219973 |
Authorized person
Name | RITV KUMAR PAHWA |
Role | BILLING |
Phone | 2563486087 |
Taxonomy
Taxonomy Code | 208D00000X - General Practice Physician |
License Number | 00010377 |
State | AL |
Is Primary | Yes |
Other Provider Identifiers
Issuer | MEDICAID |
Number | 529913720 |
State | AL |
Issuer | MEDICAID |
Number | 009912735 |
State | AL |
Name | Role |
---|---|
GULATI, PREM K | Agent |
Name | Role |
---|---|
GULATI, PREM K | Incorporator |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State