| Name: | COASTAL FAMILY MEDICINE, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 06 Jun 2017 (7 years ago) |
| Entity Number: | 000-393-599 |
| Register Number: | 000393599 |
| County: | Baldwin |
| Place of Formation: | Baldwin County |
| Registered Office Street Address: | 7053 ROCKY ROAD LOOPGULF SHORES, AL 36542 |
| Registered Office Street Address ZIP Code: | 36542 |
| Principal Address: | 1807 NORTH MCKENZIE STREETFOLEY, AL 36535 |
| Principal Address ZIP Code: | 36535 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1750911574 | 2020-01-21 | 2022-05-31 | 1807 N MCKENZIE ST, FOLEY, AL, 365352326, US | 1807 N MCKENZIE ST, FOLEY, AL, 365352326, US | |||||||||||||||
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| Phone | +1 251-215-4004 |
| Phone | +1 251-213-5824 |
Authorized person
| Name | MRS. NICOLE MANAS BODINE |
| Role | NURSE PRACTITIONER |
| Phone | 2512135824 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| BODINE, NICOLE | Organizer | 7053 ROCKY ROAD LOOPGULF SHORES, AL 36542 |
| Name | Role | Address |
|---|---|---|
| BODINE, NICOLE | Agent | 7053 ROCKY ROAD LOOPGULF SHORES, AL 36542 |
Date of last update: 13 Aug 2024
Sources: Alabama Secretary of State
