| Name: | Southern Neonatal Nurse Practitioners, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 22 Aug 2018 (6 years ago) |
| Entity Number: | 000-527-686 |
| Register Number: | 000527686 |
| County: | Jefferson |
| Place of Formation: | Jefferson County |
| Registered Office Street Address: | 400 CENTURY PARK S. #224BIRMINGHAM, AL 35226 |
| Registered Office Street Address ZIP Code: | 35226 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1144796673 | 2018-10-23 | 2018-10-23 | 8524 HAYES RD, BESSEMER, AL, 350227926, US | 995 9TH AVE SW, BESSEMER, AL, 350224527, US | |||||||||||||||||||||||||||
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| Phone | +1 205-531-2755 |
| Fax | 2055657939 |
Authorized person
| Name | CYNTHIA GALLOWAY |
| Role | VICE PRESIDENT/CRNP |
| Phone | 2055312755 |
Taxonomy
| Taxonomy Code | 363LN0000X - Neonatal Nurse Practitioner |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 111EP1111X |
| State | AL |
| Issuer | MEDICAID |
| Number | 363L00000X |
| State | AL |
| Name | Role |
|---|---|
| THOMPSON, MARY S | Agent |
| Name | Role | Address |
|---|---|---|
| THOMPSON, MARY STEWART | Organizer | 400 CENTURY PARK S #224BIRMINGHAM, AL 35226 |
Date of last update: 14 Aug 2024
Sources: Alabama Secretary of State
