| Name: | Hanceville Primary Healthcare, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 21 Jul 2016 (8 years ago) |
| Entity Number: | 000-367-574 |
| Register Number: | 000367574 |
| County: | Cullman |
| Place of Formation: | Cullman County |
| Registered Office Street Address: | 1407 EDWARD STREETHANCEVILLE, AL 35077 |
| Registered Office Street Address ZIP Code: | 35077 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1619488913 | 2017-10-13 | 2018-04-25 | 1009 MAIN ST NW, HANCEVILLE, AL, 350777949, US | 1009 MAIN ST NW, HANCEVILLE, AL, 350777949, US | |||||||||||||||||||||||||||
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| Phone | +1 256-887-1751 |
Authorized person
| Name | ALLIE BARNETT |
| Role | OFFICE MANAGER |
| Phone | 2568871571 |
Taxonomy
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 209906 |
| State | AL |
| Issuer | BLUE CROSS BLUE SHIELD OF ALABAMA |
| Number | 512-01510 |
| State | AL |
| Name | Role |
|---|---|
| NAIL, SABRINA | Agent |
Date of last update: 13 Aug 2024
Sources: Alabama Secretary of State
