| 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) (Companies founded in May 2008) |
| Entity Number: | 000-419-779 |
| Register Number: | 000419779 |
| Historical Names: |
Frosty Snowman, L.L.C.
|
| ZIP code: | 35961 (Companies in De Kalb, 35961) |
| County: | De Kalb |
| Place of Formation: | DeKalb County |
| Principal Address: | COLLINSVILLE, AL |
| Registered Office Street Address: | 13280 CO RD 51COLLINSVILLE, AL 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 | |||||||||||||||||||||||||||
|
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| 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
