| Name: | Reagan's Clinic, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 24 Jan 2024 (10 months ago) |
| Entity Number: | 001-117-818 |
| Register Number: | 001117818 |
| County: | Madison |
| Place of Formation: | Alabama |
| Registered Office Street Address: | 12205 County Line Road, Suite CMadison, AL 35758 |
| Registered Office Street Address ZIP Code: | 35758 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1558123190 | 2024-01-29 | 2024-02-23 | 12205 COUNTY LINE RD STE C, MADISON, AL, 357587720, US | 12205 COUNTY LINE RD STE C, MADISON, AL, 357587720, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 563-424-0459 |
Authorized person
| Name | DR. MARC A HULTQUIST |
| Role | CEO |
| Phone | 2562588319 |
Taxonomy
| Taxonomy Code | 208000000X - Pediatrics Physician |
| Is Primary | No |
| Taxonomy Code | 2080P0006X - Developmental - Behavioral Pediatrics Physician |
| Is Primary | Yes |
| Taxonomy Code | 2080P0008X - Pediatric Neurodevelopmental Disabilities Physician |
| Is Primary | No |
| Taxonomy Code | 261QD1600X - Developmental Disabilities Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 363LF0000X - Family Nurse Practitioner |
| Is Primary | No |
| Name | Role |
|---|---|
| Hultquist, Marc | Agent |
Date of last update: 18 Aug 2024
Sources: Alabama Secretary of State
