| Name: | Hazel Green Family Practice, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 02 May 2002 (23 years ago) (Companies founded in May 2002) |
| Entity Number: | 000-222-712 |
| Register Number: | 000222712 |
| Place of Formation: | Madison County |
| Principal Address: | HAZEL GREEN, AL |
| Registered Office Street Address: | 13741 HIGHWAY 231/431 NORTHHAZEL GREEN, AL 35750-8647 |
| Authorized Capital: | $1,000 |
Activities
PRACTICE MEDICINE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1598877284 | 2006-08-31 | 2020-08-22 | 12801 HIGHWAY 231/431, HAZEL GREEN, AL, 35750, US | 12801 HIGHWAY 231/431, HAZEL GREEN, AL, 35750, US | |||||||||||||||||||||||||
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| Phone | +1 256-828-6720 |
| Fax | 2568287230 |
Authorized person
| Name | DR. BOBBY JAMES NEWBELL |
| Role | CEO |
| Phone | 2568286720 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | 22921 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | 51507428 |
| State | AL |
| Name | Role |
|---|---|
| NEWBELL, BOBBY J | Incorporator |
| Name | Role |
|---|---|
| NEWBELL, BOBBY J | Agent |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
