| Name: | Grant Family Medicine, L.L.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Dissolved |
| Date of registration: | 03 Jan 2001 (24 years ago) (Companies founded in January 2001) |
| Date of dissolution: | 25 Mar 2015 |
| Entity Number: | 000-673-376 |
| Register Number: | 000673376 |
| ZIP code: | 35747 (Companies in Marshall, 35747) |
| County: | Marshall |
| Place of Formation: | Marshall County |
| Principal Address: | GRANT, AL |
| Registered Office Street Address: | 4500 MAIN STGRANT, AL 35747 |
Activities
PRACTICE OF MEDICINE/HEALING ARTS
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1316948649 | 2005-08-09 | 2020-08-22 | 4500 MAIN ST, GRANT, AL, 357478303, US | 4500 MAIN ST, GRANT, AL, 357478303, US | |||||||||||||||||||||||||||||||
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| Phone | +1 256-728-8600 |
| Fax | 2567288602 |
Authorized person
| Name | HILDA BERNICE CRAZE |
| Role | OWNER |
| Phone | 2567288600 |
Taxonomy
| Taxonomy Code | 261Q00000X - Clinic/Center |
| License Number | 12795 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | AETNA |
| Number | 404999 |
| State | AL |
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | 51000192 |
| State | AL |
| Name | Role |
|---|---|
| CRAZE, BERNICE | Agent |
| Name | Role |
|---|---|
| CRAZE, BERNICE | Member |
Date of last update: 15 Aug 2024
Sources: Alabama Secretary of State
