| Name: | North River Internal Medicine, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 18 Jul 2018 (6 years ago) |
| Entity Number: | 000-524-405 |
| Register Number: | 000524405 |
| County: | Tuscaloosa |
| Place of Formation: | Tuscaloosa County |
| Registered Office Street Address: | 100 RICE MINE ROAD NORTH STE 150TUSCALOOSA, AL 35406 |
| Registered Office Street Address ZIP Code: | 35406 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1376035543 | 2018-06-04 | 2020-12-17 | 1110 DR. EDWARD HILLARD DRIVE SUITE A, TUSCALOOSA, AL, 354017446, US | 100 RICE MINE RD N SUITE 150, TUSCALOOSA, AL, 354062375, US | |||||||||||||||||||||||||||||||||||
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| Phone | +1 205-333-4655 |
| Fax | 2053334660 |
| Phone | +1 205-764-2362 |
Authorized person
| Name | DR. JAMES B WILHITE |
| Role | MEDICAL DOCTOR |
| Phone | 2057642362 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 216168 |
| State | AL |
| Issuer | MEDICAID |
| Number | 222956 |
| State | AL |
| Issuer | MEDICAID |
| Number | 216663 |
| State | AL |
| Name | Role |
|---|---|
| WILHITE, J B | Agent |
| Name | Role | Address |
|---|---|---|
| WILHITE, J BRIAN | Organizer | 100 RICE MINE ROAD NORTH STE 150TUSCALOOSA, AL 35406 |
Date of last update: 14 Aug 2024
Sources: Alabama Secretary of State
