| Name: | QHG of Jacksonville, Inc. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Non-Profit Corporation |
| Status: | Merged |
| Date of registration: | 17 Apr 1996 (29 years ago) |
| Entity Number: | 000-179-471 |
| Register Number: | 000179471 |
| ZIP code: | 36207 |
| County: | Calhoun |
| Place of Formation: | Calhoun County |
| Principal Address: | 400 EAST TENTH STREETANNISTON, AL 36207 |
| Authorized Capital: | $1,000 |
| Paid Share Capital: | -- |
Activities
ANY LAWFUL ACTIVITY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1457458820 | 2006-09-20 | 2008-02-08 | 7100 COMMERCE WAY, SUITE 180, BRENTWOOD, TN, 370272829, US | 1701 PELHAM RD S, JACKSONVILLE, AL, 362653353, US | |||||||||||||||||||||||||
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| Phone | +1 256-435-4970 |
Authorized person
| Name | DEBBIE BREWER |
| Role | DIRECTOR OF PROVIDER ENROLLMENT |
| Phone | 8778929813 |
Taxonomy
| Taxonomy Code | 207L00000X - Anesthesiology Physician |
| Is Primary | Yes |
| Taxonomy Code | 207P00000X - Emergency Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 367500000X - Certified Registered Nurse Anesthetist |
| Is Primary | No |
| Name | Role |
|---|---|
| MCCORMACK, J D | Agent |
| Name | Role | Address |
|---|---|---|
| KERNION, GREGORY J | Director | 400 EAST TENTH STREETANNISTON, AL 36207 |
| SUDDUTH, SANDRA F | Director | 400 EAST TENTH STREETANNISTON, AL 36207 |
| BROWN, EDDYER L | Director | 400 EAST TENTH STREETANNISTON, AL 36207 |
| DEASON, LARRY K | Director | 400 EAST TENTH STREETANNISTON, AL 36207 |
| FITE, ARTHUR F III | Director | 722 HILLYER HIGH ROADANNISTON, AL 36207 |
| GRIZZARD, BILLY D | Director | 400 EAST TENTH STREETANNISTON, AL 36207 |
| HARDEGREE, TRUDY D | Director | 400 EAST TENTH STREETANNISTON, AL 36207 |
| COLLINS, JEFF MD | Director | 400 EAST TENTH STREETANNISTON, AL 36207 |
| KIMBERLY, MICHAEL W PHD | Director | 400 EAST TENTH STREETANNISTON, AL 36207 |
| PARKER, JEFFREY A | Director | 400 EAST TENTH STREETANNISTON, AL 36207 |
| Name | Role |
|---|---|
| JENKINS, GAYLE | Incorporator |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
