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Wills Valley Family Medicine, L.L.C.

Details

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

National Provider Identifier

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

Contacts

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

Agent

Name Role Address
KOE, FRANCES H Agent 1676 CO.RD. 12COLLINSVILLE, AL 35961

Member

Name Role Address
KOE, FRANCES H Member 1676 CO.RD. 12COLLINSVILLE, AL 35961

Events

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