| Name: | Family Health Clinic of Union Springs, Inc. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Corporation |
| Status: | Exists |
| Date of registration: | 12 Jun 2007 (17 years ago) (Companies founded in June 2007) |
| Entity Number: | 000-252-998 |
| Register Number: | 000252998 |
| ZIP code: | 36089 (Companies in Bullock, 36089) |
| County: | Bullock |
| Place of Formation: | Bullock County |
| Principal Address: | UNION SPRINGS, AL |
| Registered Office Street Address: | 309 PRAIRIE STREET NORTHUNION SPRINGS, AL 36089 |
| Authorized Capital: | $1,000 |
Activities
MEDICAL PRACTICE
| Unique Entity ID | Expiration Date | Physical Address | Mailing Address | |||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| S4ZVGF31J1F5 | 2021-12-29 | 309 PRAIRIE ST N, UNION SPRINGS, AL, 36089, 1418, USA | 309 PRAIRIE ST N, UNION SPRINGS, AL, 36089, 1418, USA | |||||||||||||||||||||||||||||||||||||||
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| Congressional District | 02 |
| State/Country of Incorporation | AL, USA |
| Activation Date | 2020-12-30 |
| Initial Registration Date | 2020-11-20 |
| Entity Start Date | 2008-05-01 |
| Fiscal Year End Close Date | Dec 31 |
Points of Contacts
| Electronic Business | |
|---|---|
| Title | PRIMARY POC |
| Name | CAROL M HOLDER |
| Role | PRESIDENT |
| Address | 309 PRAIRIE ST N, UNION SPRINGS, AL, 36089, USA |
| Government Business | |
|---|---|
| Title | PRIMARY POC |
| Name | CAROL M HOLDER |
| Role | PRESIDENT |
| Address | 309 PRAIRIE ST N, UNION SPRINGS, AL, 36089, USA |
| Past Performance | Information not Available |
|---|
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1073001053 | 2018-04-25 | 2018-06-16 | 309 PRAIRIE ST N, UNION SPRINGS, AL, 360891418, US | 309 PRAIRIE ST N, UNION SPRINGS, AL, 360891418, US | |||||||||||||||||||||||||
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| Phone | +1 334-473-8795 |
| Fax | 3344084681 |
Authorized person
| Name | CAROL MCMILLAN HOLDER |
| Role | ADMINISTRATOR |
| Phone | 3344738795 |
Taxonomy
| Taxonomy Code | 261QR1300X - Rural Health Clinic/Center |
| License Number | 9450011701 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 138855 |
| State | AL |
| Name | Role |
|---|---|
| HOLDER, CAROL M | Agent |
| Name | Role | Address |
|---|---|---|
| MAIN, BEN SR | Incorporator | No data |
| RUMP, WILL | Incorporator | No data |
| MAIN, THOMAS | Incorporator | 8451 TIMBERCREEK DRIVEPIKE ROAD, AL 36064 |
| TANNER, KRISTY | Incorporator | No data |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
