| Name: | PINELEAF EMERGENCY PHYSICIANS, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 16 Oct 2013 (11 years ago) (Companies founded in October 2013) |
| Entity Number: | 000-289-627 |
| Register Number: | 000289627 |
| ZIP code: | 36104 (Companies in Montgomery, 36104) |
| County: | Montgomery |
| Place of Formation: | Montgomery County |
| Principal Address: | 6200 S SYRACUSE WAY STE 200GREENWOOD VILLAGE, CO 80111 |
| Registered Office Street Address: | 641 S LAWRENCE STMONTGOMERY, AL 36104 |
Activities
MEDICAL BILLING FOR AREA HOSPITALS
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1144279993 | 2006-05-09 | 2023-03-30 | 13737 NOEL RD, STE 1600, DALLAS, TX, 752401331, US | 1301 BELLEVILLE AVE, BREWTON, AL, 364261306, US | |||||||||||||||||||||
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| Phone | +1 954-838-2371 |
| Phone | +1 251-867-8061 |
Authorized person
| Name | KAREN VAUGHN |
| Role | OFFICER |
| Phone | 9732511132 |
Taxonomy
| Taxonomy Code | 207P00000X - Emergency Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 529925760 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| CORPORATION SERVICE COMPANY | Agent | 641 SOUTH LAWRENCE STREETMONTGOMERY, AL 36104 |
| Name | Role | Address |
|---|---|---|
| EMCARE PHYSICIAN PROVIDERS INC | Organizer | 6200 SOUTH SYRACUSE WAY SUITE 200GREENWOOD VILLAGE, CO 80111 |
| WILSON, CRAIG | Organizer | 6200 S SYRACUSE WAY STE 200GREENWOOD VILLAGE, CO 80111 |
| Event Date | Event Type | Old Value | New Value |
|---|---|---|---|
| 2013-10-23 | Name Merged | No data | PINELEAF EMERGENCY PHYSICIANS * Not On File Into Domestic |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
