| Name: | MedExpress Littleville, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Dissolved |
| Date of registration: | 31 Jan 2014 (11 years ago) |
| Date of dissolution: | 17 Jun 2020 |
| Entity Number: | 000-296-102 |
| Register Number: | 000296102 |
| County: | Franklin |
| Place of Formation: | Colbert County |
| Registered Office Street Address: | 1369A GEORGE WALLACE HIGHWAYRUSSELLVILLE, AL 35654 |
| Registered Office Street Address ZIP Code: | 35654 |
Activities
HEALTH CARE FACILITIES / OUTPATIENT MEDICAL CLINICS
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1669830881 | 2016-02-02 | 2016-02-02 | 1369A GEORGE WALLACE HWY, RUSSELLVILLE, AL, 356543281, US | 1369A GEORGE WALLACE HWY, RUSSELLVILLE, AL, 356543281, US | |||||||||||||||||||||||||
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| Phone | +1 256-331-9700 |
| Fax | 2563312615 |
Authorized person
| Name | VINCENT BONETTI |
| Role | EXECUTIVE DIRECTOR, REVENUE CYCLE |
| Phone | 2562659641 |
Taxonomy
| Taxonomy Code | 261QR1300X - Rural Health Clinic/Center |
| License Number | B1705 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 169067 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| JONES, GLEN M | Agent | 221 HOSPITAL ROADRED BAY, AL 35582 |
| Name | Role | Address |
|---|---|---|
| JONES, GLEN M | Organizer | 221 HOSPITAL ROADRED BAY, AL 35582 |
| ARNOLD, W DOUGLAS | Organizer | 1300 SOUTH MONTGOMERY AVENUESHEFFIELD, AL 35660 |
| STRICKLAND, MORRIS S | Organizer | 1300 SOUTH MONTGOMERY AVENUESHEFFIELD, AL 35660 |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
