| 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 | |||||||||||||||||||||||||||||||
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| 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
