| Name: | Hartselle Emergency Services, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Foreign Limited Liability Company |
| Status: | Withdrawn |
| Date of registration: | 15 Jun 1999 (25 years ago) (Companies founded in June 1999) |
| Entity Number: | 000-601-700 |
| Register Number: | 000601700 |
| ZIP code: | 36104 (Companies in Montgomery, 36104) |
| County: | Montgomery |
| Place of Formation: | North Carolina |
| Principal Address: | 6400 ATLANTIC BLVDJACKSONVILLE, FL 32211 |
| Registered Office Street Address: | 2 NORTH JACKSON ST., SUITE 605MONTGOMERY, AL 36104 |
Activities
PROVIDE ADMIN/MGMT SVS TO PHYSICIANS/HEALTHCARE PROVIDERS
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1386884211 | 2009-03-05 | 2009-09-04 | PO BOX 863535, ORLANDO, FL, 328863535, US | 42024 HIGHWAY 195, HALEYVILLE, AL, 355657054, US | |||||||||||||||||||||
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| Phone | +1 800-514-1494 |
| Phone | +1 205-485-7371 |
Authorized person
| Name | ROBERT J BUNKER |
| Role | CEO |
| Phone | 9048051300 |
Taxonomy
| Taxonomy Code | 207P00000X - Emergency Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 108861 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| C T CORPORATION SYSTEM | Agent | 2 NORHT JACKSON STREET SUITE 605MONTGOMERY, AL 36104 |
Date of last update: 14 Aug 2024
Sources: Alabama Secretary of State
