| Name: | Northside Primary Care, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 12 Sep 2022 (2 years ago) |
| Entity Number: | 001-039-464 |
| Register Number: | 001039464 |
| County: | Tuscaloosa |
| Place of Formation: | Alabama |
| Registered Office Street Address: | 19428 Gorgas RoadNorthport, AL 35475 |
| Registered Office Street Address ZIP Code: | 35475 |
| Principal Address: | 19570 GORGAS RDNORTHPORT, AL 35475 |
| Principal Address ZIP Code: | 35475 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1922716018 | 2022-11-08 | 2022-11-08 | 19570 GORGAS RD, NORTHPORT, AL, 354751912, US | 19570 GORGAS RD, NORTHPORT, AL, 354751912, US | |||||||||||||
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| Phone | +1 205-349-9444 |
Authorized person
| Name | CHRISTINE FALLS |
| Role | OWNER/PROVIDER |
| Phone | 2053499444 |
Taxonomy
| Taxonomy Code | 363LF0000X - Family Nurse Practitioner |
| Is Primary | Yes |
| Name | Role |
|---|---|
| Falls, Christine | Agent |
Date of last update: 17 Aug 2024
Sources: Alabama Secretary of State
