Name: | Wills Valley Family Medicine, L.L.C. |
Jurisdiction: | Alabama |
Legal type: | Domestic Limited Liability Company |
Status: | Exists |
Date of registration: | 07 May 2008 (17 years ago) |
Entity Number: | 000-419-779 |
Register Number: | 000419779 |
Historical Names: |
Frosty Snowman, L.L.C.
|
County: | De Kalb |
Place of Formation: | DeKalb County |
Principal Address: | COLLINSVILLE, AL |
Registered Office Street Address: | 13280 CO RD 51COLLINSVILLE, AL 35961 |
Registered Office Street Address ZIP Code: | 35961 |
Activities
ANY LAWFUL ACTIVITY
NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1316103237 | 2008-07-30 | 2008-10-28 | 13280 COUNTY ROAD 51, COLLINSVILLE, AL, 359614174, US | 13280 COUNTY ROAD 51, COLLINSVILLE, AL, 359614174, US | |||||||||||||||||||||||||||
|
Phone | +1 256-524-3090 |
Fax | 2565242885 |
Authorized person
Name | FRANCES H KOE |
Role | OWNER |
Phone | 2565243090 |
Taxonomy
Taxonomy Code | 207Q00000X - Family Medicine Physician |
Is Primary | Yes |
Other Provider Identifiers
Issuer | MEDICAID |
Number | 1316103237 |
State | AL |
Issuer | MEDICARE PTAN |
Number | 510I080356 |
State | AL |
Name | Role | Address |
---|---|---|
KOE, FRANCES H | Agent | 1676 CO.RD. 12COLLINSVILLE, AL 35961 |
Name | Role | Address |
---|---|---|
KOE, FRANCES H | Member | 1676 CO.RD. 12COLLINSVILLE, AL 35961 |
Event Date | Event Type | Old Value | New Value |
---|---|---|---|
2008-05-22 | Name Change | Frosty Snowman, L.L.C. | Wills Valley Family Medicine, L.L.C. |
Date of last update: 13 Aug 2024
Sources: Alabama Secretary of State