| Name: | Rainsville Family Practice, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 23 Sep 2005 (19 years ago) (Companies founded in September 2005) |
| Entity Number: | 000-470-017 |
| Register Number: | 000470017 |
| ZIP code: | 35986 (Companies in De Kalb, 35986) |
| County: | De Kalb |
| Place of Formation: | DeKalb County |
| Principal Address: | RAINSVILLE, AL |
| Registered Office Street Address: | 504 MCCURDY AVENUE SOUTH STE 6RAINSVILLE, AL 35986 |
Activities
ANY LAWFUL ACTIVITY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1164679676 | 2008-08-26 | 2013-01-24 | 421 MEDICAL CENTER DR SW, FORT PAYNE, AL, 359683421, US | 421 MEDICAL CENTER DR SW, FORT PAYNE, AL, 359683421, US | |||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 256-845-1401 |
| Fax | 2568451402 |
Authorized person
| Name | THOMAS LEON HORTON |
| Role | OWNER |
| Phone | 2568451401 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | 13953 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS BLUE SHIELD OF TENNESSEE |
| Number | 4221491 |
| State | TN |
| Issuer | BCBS OF AL |
| Number | 51107803 |
| State | AL |
| Issuer | RR MEDICARE |
| Number | P00664321 |
| Issuer | MEDICAID |
| Number | 142769 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| HORTON, THOMAS | Agent | 2446 HUNTINGTON GLEN DRHOMEWOOD, AL 35226 |
| Name | Role | Address |
|---|---|---|
| HORTON, THOMAS | Member | 2446 HUNTINGTON GLEN DRHOMEWOOD, AL 35226 |
Date of last update: 14 Aug 2024
Sources: Alabama Secretary of State
