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Crestani Family Medicine, P.C.

Details

Name: Crestani Family Medicine, P.C.
Jurisdiction: Alabama
Legal type: Domestic Professional Corporation
Status: Exists
Date of registration: 21 Dec 2005 (19 years ago)
Entity Number: 000-244-782
Register Number: 000244782
County: Madison
Place of Formation: Madison County
Principal Address: HUNTSVILLE, AL
Registered Office Street Address: 2400 BOB WALLACE AVE STE 101HUNTSVILLE, AL 35805
Registered Office Street Address ZIP Code: 35805
Authorized Capital: $1,000
Paid Share Capital: $1,000

Activities ANY LAWFUL ACTIVITY

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1033166178 2006-05-27 2020-08-22 PO BOX 2586, HUNTSVILLE, AL, 358042586, US 2745 BOB WALLACE AVE SW, SUITE D, HUNTSVILLE, AL, 358054158, US

Contacts

Phone +1 256-534-1323
Fax 2565341780

Authorized person

Name PANDA JO PALMER
Role ACCOUNTS MANAGER
Phone 2565341323

Taxonomy

Taxonomy Code 207Q00000X - Family Medicine Physician
License Number 23539
State AL
Is Primary Yes

Incorporator

Name Role
CRESTANI, MARY MARGARET Incorporator

Agent

Name Role
LAMBERT, MICHAEL C Agent

Date of last update: 02 Aug 2024

Sources: Alabama Secretary of State