| Name: | Helena's Family Doctor, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 25 Jun 2002 (23 years ago) |
| Entity Number: | 000-683-164 |
| Register Number: | 000683164 |
| ZIP code: | 35080 |
| County: | Shelby |
| Place of Formation: | Shelby County |
| Principal Address: | HELENA, AL |
| Registered Office Street Address: | 769-2ND STHELENA, AL 35080 |
Activities
FAMILY MEDICINE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1841475902 | 2008-01-07 | 2012-07-13 | 775 2ND ST, HELENA, AL, 350803209, US | 775 2ND ST, HELENA, AL, 350803209, US | |||||||||||||||||||
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| Phone | +1 205-664-9990 |
| Fax | 2056648882 |
Authorized person
| Name | DR. DAVID BURTON AIZENMAN |
| Role | OWNER/SOLO PRACTITIONER |
| Phone | 2056649990 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | 17215 |
| State | AL |
| Is Primary | Yes |
| CAGE number | Status | Type | Established | CAGE Update Date | CAGE Expiration | SAM Expiration | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 6YTA5 | Active | Non-Manufacturer | 2013-09-04 | 2014-09-02 | No data | No data | |||||||||||||||
|
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| POC | DAVID B. AIZENMAN |
| Phone | +1 205-664-9990 |
| Fax | +1 205-664-8882 |
| Address | 775 2ND ST, HELENA, AL, 35080 3209, UNITED STATES |
Ownership of Offeror Information
| Highest Level Owner | Information not Available |
|---|
| Immediate Level Owner | Information not Available |
|---|
| List of Offerors (0) | Information not Available |
|---|
| Name | Role |
|---|---|
| AIZENMAN, DAVID B | Agent |
| Name | Role |
|---|---|
| AIZENMAN, DAVID B | Member |
Date of last update: 15 Aug 2024
Sources: Alabama Secretary of State
