| Name: | Summit Express Urgent Care, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 30 Jul 2013 (11 years ago) |
| Entity Number: | 000-284-214 |
| Register Number: | 000284214 |
| ZIP code: | 35209 |
| County: | Jefferson |
| Place of Formation: | Jefferson County |
| Registered Office Street Address: | 2000 SOUTHBRIDGE PARKWAY SUITE 605BIRMINGHAM, AL 35209 |
Activities
MEDICAL TREATMENT
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1528489259 | 2013-12-23 | 2013-12-23 | 4322 KINGS MOUNTAIN RDG, VESTAVIA, AL, 352422242, US | 1360 MONTGOMERY HWY, SUITE 124, VESTAVIA, AL, 352162749, US | |||||||||||||||||||||||
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| Phone | +1 205-329-4565 |
Authorized person
| Name | DR. L NICOL PETTWAY |
| Role | OWNER |
| Phone | 2053294565 |
Taxonomy
| Taxonomy Code | 261Q00000X - Clinic/Center |
| License Number | 19390 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | NPI |
| Number | 1376588095 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| PETTWAY, NICOL | Agent | 2000 SOUTHBRIDGE PARKWAY SUITE 605BIRMINGHAM, AL 35209 |
| Name | Role | Address |
|---|---|---|
| PETTWAY, NICOL | Organizer | 2000 SOUTHBRIDGE PARKWAY SUITE 605BIRMINGHAM, AL 35209 |
| PETTWAY, BRUCE | Organizer | 2000 SOUTHBRIDGE PARKWAY SUITE 605BIRMINGHAM, AL 35209 |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
