| Name: | Premier Family Medicine, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Dissolved |
| Date of registration: | 15 Nov 2004 (20 years ago) |
| Date of dissolution: | 27 Jul 2015 |
| Entity Number: | 000-238-368 |
| Register Number: | 000238368 |
| County: | Madison |
| Place of Formation: | Madison County |
| Principal Address: | HUNTSVILLE, AL |
| Registered Office Street Address: | 2624 WHITESBURG DRHUNTSVILLE, AL 35801 |
| Registered Office Street Address ZIP Code: | 35801 |
| Authorized Capital: | 200 NPV |
Activities
PROVIDE MEDICAL SERVICES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1124216932 | 2007-10-05 | 2013-02-22 | 4820 UNIVERSITY DR NW STE 35, HUNTSVILLE, AL, 358161824, US | 4820 UNIVERSITY DR NW STE 35, HUNTSVILLE, AL, 358161824, US | |||||||||||||||||||||||||||||||
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| Phone | +1 256-721-9444 |
| Fax | 2567210069 |
Authorized person
| Name | DR. FRANCENE A GAYLE |
| Role | OWNER |
| Phone | 2567219444 |
Taxonomy
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| License Number | 25786 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 051555502 |
| State | AL |
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | 51000429 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| GAYLE, FRANCENE | Agent | 120 GABLES BROOK DRIVEHUNTSVILLE, AL 35806 |
| Name | Role | Address |
|---|---|---|
| GAYLE, FRANCENE | Incorporator | 120 GABLES BROOK DRIVEHUNTSVILLE, AL 35806 |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
