| Name: | Greystone Family Medicine, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 05 Aug 2015 (9 years ago) |
| Entity Number: | 000-342-011 |
| Register Number: | 000342011 |
| County: | Shelby |
| Place of Formation: | Shelby County |
| Principal Address: | 6930 Cahaba Valley Road, Suite 102Birmingham, AL 35242 |
| Principal Address ZIP Code: | 35242 |
| Registered Office Street Address: | 6930 CAHABA VALLEY ROAD, SUITE 102BIRMINGHAM, AL 35242 |
| Registered Office Street Address ZIP Code: | 35242 |
| Authorized Capital: | 1,000 @ $1.00PV |
Activities
PRACTICE MEDICINE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1083080907 | 2015-08-14 | 2016-02-08 | 6930 CAHABA VALLEY RD STE 102, BIRMINGHAM, AL, 352422673, US | 6930 CAHABA VALLEY RD STE 102, BIRMINGHAM, AL, 352422673, US | |||||||||||||||||||||
|
|||||||||||||||||||||||||
| Phone | +1 205-783-5207 |
| Fax | 2057835210 |
Authorized person
| Name | MICHAEL C SWANSON |
| Role | OWNER |
| Phone | 2057835207 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 177403 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| SWANSON, MICHAEL C | Agent | 6930 CAHABA VALLEY ROAD, SUITE 102BIRMINGHAM, AL 35242 |
| Name | Role | Address |
|---|---|---|
| Amanda T Shaw | Director | 6930 Cahaba Valley Rd Suite 102Birmingham, AL 35242 |
| Name | Role | Address |
|---|---|---|
| SWANSON, MICHAEL C | Incorporator | 6930 CAHABA VALLEY ROAD, SUITE 102BIRMINGHAM, AL 35242 |
Date of last update: 03 Aug 2024
Sources: Alabama Secretary of State
