| Name: | Holifield Clinic, L.L.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Dissolved |
| Date of registration: | 01 Mar 1994 (31 years ago) (Companies founded in March 1994) |
| Date of dissolution: | 12 Mar 2019 |
| Entity Number: | 000-650-450 |
| Register Number: | 000650450 |
| ZIP code: | 36732 (Companies in Marengo, 36732) |
| County: | Marengo |
| Place of Formation: | Marengo County |
| Registered Office Street Address: | 1100 SOUTH CEDAR AVENUEDEMOPOLIS, AL 36732 |
| Principal Address: | 1100 SOUTH CEDAR STDEMOPOLIS, AL 36732 |
Activities
ACQUIRE/OWN/OPERATE/MANAGE/MORTGAGE/DEAL WITH INVESTMENTS
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1568525855 | 2006-12-18 | 2023-03-07 | 1100 S CEDAR AVE, DEMOPOLIS, AL, 367323310, US | 1100 S CEDAR AVE, DEMOPOLIS, AL, 367323310, US | |||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 334-289-2190 |
| Fax | 3342892195 |
Authorized person
| Name | MRS. HEATHER PATRICK CAMPBELL |
| Role | OFFICE MANAGER |
| Phone | 3342892190 |
Taxonomy
| Taxonomy Code | 261QC1500X - Community Health Clinic/Center |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | PRESCRIPTIVE# |
| Number | 1436 |
| State | AL |
| Issuer | AL LICENSE# |
| Number | 7780 |
| State | AL |
| Issuer | ACOG# |
| Number | 0308385 |
| State | AL |
| Issuer | AL LICENSE# |
| Number | 1-045972 |
| State | AL |
| Issuer | MEDICAID |
| Number | 85905-COW |
| State | AL |
| Name | Role |
|---|---|
| HOLIFIELD, REESE M | Agent |
| Name | Role |
|---|---|
| HOLIFIELD, REESE M | Member |
| HODGE, GERALD M | Member |
Date of last update: 15 Aug 2024
Sources: Alabama Secretary of State
