| Name: | Jeff W. Bush, M.D. Family Practice, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 08 Jun 2009 (15 years ago) (Companies founded in June 2009) |
| Entity Number: | 000-434-651 |
| Register Number: | 000434651 |
| ZIP code: | 36027 (Companies in Barbour, 36027) |
| County: | Barbour |
| Place of Formation: | Barbour County |
| Principal Address: | EUFAULA, AL |
| Registered Office Street Address: | 617 EAST BROAD STEUFAULA, AL 36027 |
Activities
MEDICAL SERVICES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1295040582 | 2010-08-11 | 2010-08-11 | 617 E BROAD ST, STE A, EUFAULA, AL, 360271710, US | 617 E BROAD ST, STE A, EUFAULA, AL, 360271710, US | |||||||||||||||||||||||||
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| Phone | +1 334-687-3836 |
| Fax | 3346870725 |
Authorized person
| Name | DR. JEFF W BUSH |
| Role | OWNER |
| Phone | 3346873836 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | 19771 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS OF ALABAMA |
| Number | 515-98558 |
| State | AL |
| Name | Role |
|---|---|
| BUSH, JEFF W | Agent |
| Name | Role |
|---|---|
| BUSH, JEFF W | Member |
Date of last update: 13 Aug 2024
Sources: Alabama Secretary of State
