| Name: | HMC Rural Health Clinic, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 28 Dec 2000 (24 years ago) |
| Entity Number: | 000-673-456 |
| Register Number: | 000673456 |
| County: | Walker |
| Place of Formation: | Walker County |
| Registered Office Street Address: | JASPER FAMILY CLINIC BUILDING AIRPORT RDJASPER, AL 35501 |
| Registered Office Street Address ZIP Code: | 35501 |
Activities
OPERATE ONE/MORE MEDICAL CLINICS
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1174525950 | 2005-08-11 | 2019-05-09 | PO BOX 1571, JASPER, AL, 355021571, US | 2201 N AIRPORT RD, JASPER, AL, 355047058, US | |||||||||||||||||||||
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| Phone | +1 205-221-9351 |
| Fax | 2052213700 |
Authorized person
| Name | DELINDA STILES |
| Role | ASSISTANT OFFICE MANAGER |
| Phone | 2052219351 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 541003878 |
| State | AL |
| Name | Role |
|---|---|
| HUDSON, A R | Member |
| CAMP, N T | Member |
| GARDNER, ANN | Member |
| Name | Role |
|---|---|
| HUDSON, A R | Agent |
Date of last update: 15 Aug 2024
Sources: Alabama Secretary of State
