| Name: | Rose Emergency Group, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 18 Dec 2019 (5 years ago) |
| Entity Number: | 000-595-736 |
| Register Number: | 000595736 |
| County: | Montgomery |
| Place of Formation: | Montgomery County |
| Registered Office Street Address: | 2 North Jackson Street - Suite 605Montgomery, AL 36104 |
| Registered Office Street Address ZIP Code: | 36104 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1841823432 | 2020-02-21 | 2022-03-11 | 200 CORPORATE BLVD, LAFAYETTE, LA, 705083870, US | 300 MED PARK DR, THOMASVILLE, AL, 367845760, US | |||||||||||||||||||||||||||||||||||
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| Phone | +1 800-893-9698 |
| Phone | +1 334-636-2525 |
| Fax | 3346053111 |
Authorized person
| Name | LISHA C FALK |
| Role | VP OF CONTRACTING |
| Phone | 3376091221 |
Taxonomy
| Taxonomy Code | 207P00000X - Emergency Medicine Physician |
| Is Primary | Yes |
| Taxonomy Code | 208M00000X - Hospitalist Physician |
| Is Primary | No |
| Taxonomy Code | 363A00000X - Physician Assistant |
| Is Primary | No |
| Taxonomy Code | 363L00000X - Nurse Practitioner |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 248281 |
| State | AL |
| Name | Role |
|---|---|
| C T Corporation System | Agent |
Date of last update: 14 Aug 2024
Sources: Alabama Secretary of State
