| Name: | FMC Medical Clinic Millport, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 07 Jun 2016 (8 years ago) (Companies founded in June 2016) |
| Entity Number: | 000-364-252 |
| Register Number: | 000364252 |
| ZIP code: | 35406 (Companies in Tuscaloosa, 35406) |
| County: | Tuscaloosa |
| Place of Formation: | Fayette County |
| Registered Office Street Address: | 1820 RICE MINE ROAD SUITE 200TUSCALOOSA, AL 35406 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1063871184 | 2016-02-17 | 2016-06-08 | 1820 RICE MINE RD N, SUITE 200, TUSCALOOSA, AL, 354063281, US | 13530 HIGHWAY 96, MILLPORT, AL, 355762522, US | |||||||||||||||||||||||
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| Phone | +1 205-333-4661 |
| Fax | 2053334660 |
| Phone | +1 205-662-3207 |
Authorized person
| Name | MR. RYAN CAMPBELL |
| Role | DIRECTOR OF PHYSICIAN SERVICE |
| Phone | 2057596165 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 183355 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| JONES, DONALD | Agent | 119 SOUTH ASH AVENUEDEMOPOLIS, AL 36732 |
| Name | Role |
|---|---|
| SNOW, STEPHEN | Organizer |
Date of last update: 04 Aug 2024
Sources: Alabama Secretary of State
