| Name: | Greenhill Family Clinic, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 19 Jan 2007 (18 years ago) |
| Entity Number: | 000-488-970 |
| Register Number: | 000488970 |
| County: | Lauderdale |
| Place of Formation: | Lauderdale County |
| Principal Address: | KILLEN, AL |
| Registered Office Street Address: | 131 HWY 64KILLEN, AL 35645 |
| Registered Office Street Address ZIP Code: | 35645 |
Activities
PROFESSIONAL MEDICAL SERVICES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1639234982 | 2006-12-27 | 2013-06-11 | 351 HIGHWAY 64, KILLEN, AL, 35645, US | 351 HIGHWAY 64, KILLEN, AL, 35645, US | |||||||||||||||||||||||||||||||||||||
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| Phone | +1 256-272-8066 |
| Fax | 2562728375 |
Authorized person
| Name | DR. STEVE E WAMPLER |
| Role | PRESIDENT |
| Phone | 2562728066 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
| Taxonomy Code | 261QE0002X - Emergency Care Clinic/Center |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICARE RAILROAD |
| Number | DF5641 |
| State | SC |
| Issuer | MEDICAID |
| Number | 529931670 |
| State | AL |
| Issuer | DEPARTMENT OF LABOR |
| Number | 612248600 |
| State | FL |
| Name | Role |
|---|---|
| WAMPLER, STEVE M | Agent |
| Name | Role |
|---|---|
| WAMPLER, STEVE M | Member |
Date of last update: 14 Aug 2024
Sources: Alabama Secretary of State
