| Name: | HealthSource of Huntsville, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 13 May 2013 (12 years ago) (Companies founded in May 2013) |
| Entity Number: | 000-279-401 |
| Register Number: | 000279401 |
| Place of Formation: | Madison County |
Activities
ANY OR ALL LAWFUL BUSINESS
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1609209253 | 2013-08-19 | 2022-11-03 | 930 BOB WALLACE AVE SW STE 225, HUNTSVILLE, AL, 358015644, US | 930 BOB WALLACE AVE SW STE 225, HUNTSVILLE, AL, 358015644, US | |||||||||||||||||||||||||
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| Phone | +1 256-964-6678 |
| Fax | 2569646660 |
Authorized person
| Name | DR. SARAH S JACOBS |
| Role | MANAGING MEMBER |
| Phone | 2569293918 |
Taxonomy
| Taxonomy Code | 305R00000X - Preferred Provider Organization |
| License Number | 2227 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | INDIVIDUAL NPI |
| Number | 1417146143 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| JACOBS, SARAH | Organizer | 204 WESTBURG AVE SWHUNTSVILLE, AL 35801 |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
