| Name: | Greystone Back Pain Center, L.L.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Dissolved |
| Date of registration: | 12 Jan 2005 (20 years ago) |
| Date of dissolution: | 31 Dec 2008 |
| Entity Number: | 000-459-249 |
| Register Number: | 000459249 |
| County: | Shelby |
| Place of Formation: | Shelby County |
| Principal Address: | BIRMINGHAM, AL |
| Registered Office Street Address: | 101 MSSIONARY RIDGE STE 200-BBIRMINGHAM, AL 35242 |
| Registered Office Street Address ZIP Code: | 35242 |
Activities
DIAGNOSIS/TREATMENT OF MEDICAL BACK/SPINE CONDITIONS
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1831301969 | 2007-05-03 | 2020-08-22 | P.O. BOX 383021, BIRMINGHAM, AL, 352383021, US | 101 MISSIONARY RIDGE SUITE 200B, BIRMINGHAM, AL, 35242, US | |||||||||||||||||||||
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| Phone | +1 205-263-0288 |
| Fax | 2059800133 |
Authorized person
| Name | DR. DAVID B WILHELM |
| Role | PRESIDENT |
| Phone | 2052630288 |
Taxonomy
| Taxonomy Code | 261QP2000X - Physical Therapy Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | 51000762 |
| State | AL |
| Name | Role |
|---|---|
| SWANSON, CAROL J | Agent |
| Name | Role |
|---|---|
| WILHELM, DAVID | Member |
| RICHARDSON, HAL | Member |
| SWANSON, CAROL J | Member |
Date of last update: 14 Aug 2024
Sources: Alabama Secretary of State
