East Alabama Urology Associates, P.A.

Details

Name:	East Alabama Urology Associates, P.A.
Jurisdiction:	Alabama
Legal type:	Domestic Professional Association
Status:	Dissolved
Date of registration:	04 Oct 1971 (53 years ago) (Companies founded in October 1971)
Date of dissolution:	01 Jul 2021
Entity Number:	000-001-459
Register Number:	000001459
Historical Names:	Auburn-Opelika Urology Associates, P.A.
ZIP code:	36801 (Companies in Lee, 36801)
County:	Lee
Place of Formation:	Lee County
Principal Address:	121 NORTH 20TH STREETOPELIKA, AL 36801

National Provider Identifier

NPI

Enumeration Date

Last Update Date

Mailing Address

Practice Location Address

1770685588

2006-09-02

2013-02-14

121 N 20TH ST STE 19, OPELIKA, AL, 368015456, US

121 N 20TH ST STE 19, OPELIKA, AL, 368015456, US

Contacts

Phone	+1 334-749-8146
Fax	3347376432

Authorized person

Name	BONNIE KELLER
Role	ADMINISTRATOR
Phone	3347498146

Taxonomy

Taxonomy Code	208800000X - Urology Physician
Is Primary	Yes

Other Provider Identifiers

Issuer	MEDICAID
Number	529700320
State	AL

form 5500

Plan Name

Plan Year

EIN/PN

Received

Sponsor

Total number of participants

EAST ALABAMA UROLOGY 401(K) PROFIT SHARING PLAN

2020

630621303

2021-12-10

EAST ALABAMA UROLOGY ASSOCIATES, P.A.

9

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1972-09-30
Business code	621111
Sponsor’s telephone number	3347498146
Plan sponsor’s address	121 N 20TH STREET, SUITE 19, OPELIKA, AL, 36801

EAST ALABAMA UROLOGY 401(K) PROFIT SHARING PLAN

2020

630621303

2021-05-10

EAST ALABAMA UROLOGY ASSOCIATES, P.A.

13

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1972-09-30
Business code	621111
Sponsor’s telephone number	3347498146
Plan sponsor’s address	121 N 20TH STREET, SUITE 19, OPELIKA, AL, 36801

EAST ALABAMA UROLOGY 401(K) PROFIT SHARING PLAN

2019

630621303

2020-07-20

EAST ALABAMA UROLOGY ASSOCIATES, P.A.

14

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1972-09-30
Business code	621111
Sponsor’s telephone number	3347498146
Plan sponsor’s address	121 N 20TH STREET, SUITE 19, OPELIKA, AL, 36801

EAST ALABAMA UROLOGY 401(K) PROFIT SHARING PLAN

2018

630621303

2019-07-12

EAST ALABAMA UROLOGY ASSOCIATES, P.A.

15

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1972-09-30
Business code	621111
Sponsor’s telephone number	3347498146
Plan sponsor’s address	121 N 20TH STREET, SUITE 19, OPELIKA, AL, 36801

EAST ALABAMA UROLOGY 401(K) PROFIT SHARING PLAN

2017

630621303

2018-08-01

EAST ALABAMA UROLOGY ASSOCIATES, P.A.

16

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1972-09-30
Business code	621111
Sponsor’s telephone number	3347498146
Plan sponsor’s address	121 N 20TH STREET, SUITE 19, OPELIKA, AL, 36801

Member

Name	Role
MONTGOMERY, GUY A	Member
GARRETT, WILLIAM L JR DR	Member

Events

Event Date	Event Type	Old Value	New Value
1998-05-01	Name Change	Auburn-Opelika Urology Associates, P.A.	East Alabama Urology Associates, P.A.

Date of last update: 29 Jul 2024

Sources: Alabama Secretary of State