| Name: | Revive Medical Center, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 01 Nov 2022 (2 years ago) (Companies founded in November 2022) |
| Entity Number: | 001-047-208 |
| Register Number: | 001047208 |
| ZIP code: | 35565 (Companies in Winston, 35565) |
| County: | Winston |
| Place of Formation: | Alabama |
| Registered Office Street Address: | 916 Airport RdHaleyville, AL 35565 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1740996636 | 2023-01-25 | 2023-02-22 | PO BOX 1016, HALEYVILLE, AL, 355651016, US | 1728 11TH AVE, HALEYVILLE, AL, 355651506, US | |||||||||||||||||||
|
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| Phone | +1 205-485-7822 |
| Fax | 2603994004 |
Authorized person
| Name | LARRY JAKE PICKENS |
| Role | OWNER/PRESIDENT |
| Phone | 2054857822 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
| Taxonomy Code | 261QU0200X - Urgent Care Clinic/Center |
| Is Primary | No |
| Name | Role |
|---|---|
| Fowler, Whitley | Agent |
| Name | Role | Address |
|---|---|---|
| Pickens, Larry J | Organizer | 1657 Airport RdHaleyville, AL 35565 |
Date of last update: 17 Aug 2024
Sources: Alabama Secretary of State
