| Name: | Brookwood Primary Care - Grand River, L.L.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Dissolved |
| Date of registration: | 17 Sep 2007 (17 years ago) (Companies founded in September 2007) |
| Date of dissolution: | 22 Aug 2017 |
| Entity Number: | 000-499-957 |
| Register Number: | 000499957 |
| Historical Names: |
Brookwood Primary Care - Trussville, L.L.C.
|
| ZIP code: | 36104 (Companies in Montgomery, 36104) |
| County: | Montgomery |
| Place of Formation: | Montgomery County |
| Registered Office Street Address: | 2 NORTH JACKSON ST., SUITE 605MONTGOMERY, AL 36104 |
Activities
MEDICAL PRACTICE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1053794354 | 2015-07-06 | 2016-05-26 | 4902 VALLEYDALE RD, BIRMINGHAM, AL, 352424613, US | 1115 PAYTON WAY., SUITE 111, LEEDS, AL, 35094, US | |||||||||||||||||||||
|
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| Phone | +1 205-980-8099 |
| Fax | 2059802606 |
| Phone | +1 205-352-1175 |
Authorized person
| Name | MR. MICHAEL KYLE BURTNETT |
| Role | SVP, OUTPATIENT SERVICES, TENET |
| Phone | 4698932902 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
| Taxonomy Code | 207QS0010X - Sports Medicine (Family Medicine) Physician |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| C T CORPORATION SYSTEM | Agent | 2 NORHT JACKSON STREET SUITE 605MONTGOMERY, AL 36104 |
| Name | Role |
|---|---|
| BOOKWOOD PRIMARY NETWORK CARE INC | Member |
| Event Date | Event Type | Old Value | New Value |
|---|---|---|---|
| 2015-04-01 | Name Change | Brookwood Primary Care - Trussville, L.L.C. | Brookwood Primary Care - Grand River, L.L.C. |
Date of last update: 14 Aug 2024
Sources: Alabama Secretary of State
