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South Alabama Medical Clinic, LLC

Details

Name: South Alabama Medical Clinic, LLC
Jurisdiction: Alabama
Legal type: Domestic Limited Liability Company
Status: Exists
Date of registration: 29 Mar 2011 (14 years ago) (Companies founded in March 2011)
Entity Number: 000-007-703
Register Number: 000007703
ZIP code: 36619 (Companies in Mobile, 36619)
County: Mobile
Place of Formation: Mobile County
Registered Office Street Address: 8535 GATEWOOD DRIVE NORTHMOBILE, AL 36619

Activities MEDICAL CLINIC

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1386912723 2011-12-13 2024-07-23 10075 GRAND BAY WILMER RD S, GRAND BAY, AL, 365415003, US 10075 GRAND BAY WILMER RD S, GRAND BAY, AL, 365415003, US

Contacts
Phone +1 251-865-1852
Fax 2518651854

Authorized person
Name BRIDGOT PETERS
Role DIRECTOR
Phone 2518651852

Taxonomy
Taxonomy Code 101Y00000X - Counselor
Is Primary No
Taxonomy Code 101YP2500X - Professional Counselor
Is Primary No
Taxonomy Code 207Q00000X - Family Medicine Physician
Is Primary No
Taxonomy Code 207R00000X - Internal Medicine Physician
Is Primary No
Taxonomy Code 208000000X - Pediatrics Physician
Is Primary No
Taxonomy Code 261QR1300X - Rural Health Clinic/Center
Is Primary Yes

Commercial and government entity program

CAGE number Status Type Established CAGE Update Date CAGE Expiration SAM Expiration
765C0 Active Non-Manufacturer 2014-07-24 2015-07-10 No data No data

Contact Information
POC CHERRI BEDWELL
Phone +1 251-865-1852
Fax +1 251-865-1854
Address 10075 GRAND BAY WILMER RD S, GRAND BAY, MOBILE, AL, 36541 5003, 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

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
SOUTH ALABAMA MEDICAL CLINIC (WELFARE PLAN) 2023 451793854 2024-07-18 SOUTH ALABAMA MEDICAL CLINIC, LLC 12
File View Page
Three-digit plan number (PN) 951
Effective date of plan 2019-01-01
Business code 621111
Sponsor’s telephone number 2512900159
Plan sponsor’s address 10075 WILMER RD S, GRAND BAY, AL, 36541

Plan administrator’s name and address
Administrator’s EIN 472506773
Plan administrator’s name KENNION & CO., LLC
Plan administrator’s address 2828 OLD 280 COURT, SUITE 110, VESTAVIA, AL, 35243
Administrator’s telephone number 8669665457

Signature of
Role Plan administrator
Date 2024-06-18
Name of individual signing W. HAL SHEPHERD
Role Employer/plan sponsor
Date 2024-06-18
Name of individual signing W. HAL SHEPHERD
SOUTH ALABAMA MEDICAL CLINIC 401(K) PLAN 2023 451793854 2024-10-14 SOUTH ALABAMA MEDICAL CLINIC, LLC 21
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-03-15
Business code 621111
Sponsor’s telephone number 2518651852
Plan sponsor’s address 10075 GRAND BAY-WILMER RD S, GRAND BAY, AL, 365415003

Signature of
Role Plan administrator
Date 2024-10-14
Name of individual signing CHERRI BEDWELL
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2024-10-14
Name of individual signing CHERRI BEDWELL
Valid signature Filed with authorized/valid electronic signature
SOUTH ALABAMA MEDICAL CLINIC 401(K) PLAN 2022 451793854 2023-10-13 SOUTH ALABAMA MEDICAL CLINIC, LLC 22
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-03-15
Business code 621111
Sponsor’s telephone number 2518651852
Plan sponsor’s address 10075 GRAND BAY-WILMER RD S, GRAND BAY, AL, 365415003

Signature of
Role Plan administrator
Date 2023-10-13
Name of individual signing CHERRI BEDWELL
Role Employer/plan sponsor
Date 2023-10-12
Name of individual signing CHERRI BEDWELL
SOUTH ALABAMA MEDICAL CLINIC (WELFARE PLAN) 2022 451793854 2023-07-27 SOUTH ALABAMA MEDICAL CLINIC, LLC 12
File View Page
Three-digit plan number (PN) 951
Effective date of plan 2019-01-01
Business code 621111
Sponsor’s telephone number 2512900159
Plan sponsor’s address 10075 WILMER RD S, GRAND BAY, AL, 36541

Plan administrator’s name and address
Administrator’s EIN 472506773
Plan administrator’s name KENNION & CO., LLC
Plan administrator’s address 2828 OLD 280 COURT, SUITE 110, VESTAVIA, AL, 35243
Administrator’s telephone number 8669665457

Signature of
Role Plan administrator
Date 2023-07-20
Name of individual signing W. HAL SHEPHERD
Role Employer/plan sponsor
Date 2023-07-20
Name of individual signing W. HAL SHEPHERD
SOUTH ALABAMA MEDICAL CLINIC 401(K) PLAN 2021 451793854 2022-10-14 SOUTH ALABAMA MEDICAL CLINIC, LLC 20
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-03-15
Business code 621111
Sponsor’s telephone number 2518651852
Plan sponsor’s address 10075 GRAND BAY-WILMER RD S, GRAND BAY, AL, 365415003

Signature of
Role Plan administrator
Date 2022-10-14
Name of individual signing CHERRI BEDWELL
SOUTH ALABAMA MEDICAL CLINIC (WELFARE PLAN) 2021 451793854 2022-07-29 SOUTH ALABAMA MEDICAL CLINIC, LLC 12
File View Page
Three-digit plan number (PN) 951
Effective date of plan 2019-01-01
Business code 621111
Sponsor’s telephone number 2512900159
Plan sponsor’s address 10075 WILMER RD S, GRAND BAY, AL, 36541

Plan administrator’s name and address
Administrator’s EIN 472506773
Plan administrator’s name KENNION & CO., LLC
Plan administrator’s address 2828 OLD 280 COURT, SUITE 110, VESTAVIA, AL, 35243
Administrator’s telephone number 8669665457

Signature of
Role Plan administrator
Date 2022-07-20
Name of individual signing W. HAL SHEPHERD
Role Employer/plan sponsor
Date 2022-07-20
Name of individual signing W. HAL SHEPHERD
SOUTH ALABAMA MEDICAL CLINIC (WELFARE PLAN) 2020 451793854 2021-07-25 SOUTH ALABAMA MEDICAL CLINIC, LLC 10
File View Page
Three-digit plan number (PN) 951
Effective date of plan 2019-01-01
Business code 621111
Sponsor’s telephone number 2512900159
Plan sponsor’s address 10075 WILMER RD S, GRAND BAY, AL, 36541

Plan administrator’s name and address
Administrator’s EIN 472506773
Plan administrator’s name KENNION & CO., LLC
Plan administrator’s address 2828 OLD 280 COURT, SUITE 110, VESTAVIA, AL, 35243
Administrator’s telephone number 8669665457

Signature of
Role Plan administrator
Date 2021-07-20
Name of individual signing W. HAL SHEPHERD
Role Employer/plan sponsor
Date 2021-07-20
Name of individual signing W. HAL SHEPHERD
SOUTH ALABAMA MEDICAL CLINIC 401(K) PLAN 2020 451793854 2021-08-06 SOUTH ALABAMA MEDICAL CLINIC, LLC 17
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-03-15
Business code 621111
Sponsor’s telephone number 2518651852
Plan sponsor’s address 10075 GRAND BAY-WILMER RD S, GRAND BAY, AL, 365415003

Signature of
Role Plan administrator
Date 2021-08-06
Name of individual signing CHERRI BEDWELL
Role Employer/plan sponsor
Date 2021-08-06
Name of individual signing CHERRI BEDWELL
SOUTH ALABAMA MEDICAL CLINIC (WELFARE PLAN) 2019 451793854 2020-07-30 SOUTH ALABAMA MEDICAL CLINIC, LLC 0
File View Page
Three-digit plan number (PN) 951
Effective date of plan 2019-01-01
Business code 621111
Sponsor’s telephone number 2512900159
Plan sponsor’s address 10075 WILMER RD S, GRAND BAY, AL, 36541

Plan administrator’s name and address
Administrator’s EIN 472506773
Plan administrator’s name KENNION & CO., LLC
Plan administrator’s address 800 CORPORATE PKWY, STE 100, BIRMINGHAM, AL, 35242
Administrator’s telephone number 8669665457

Signature of
Role Plan administrator
Date 2020-07-29
Name of individual signing W. HAL SHEPHERD
Role Employer/plan sponsor
Date 2020-07-29
Name of individual signing W. HAL SHEPHERD
SOUTH ALABAMA MEDICAL CLINIC 401(K) PLAN 2019 451793854 2020-07-31 SOUTH ALABAMA MEDICAL CLINIC, LLC 19
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-03-15
Business code 621111
Sponsor’s telephone number 2518651852
Plan sponsor’s address 10075 GRAND BAY-WILMER RD S, GRAND BAY, AL, 365415003

Signature of
Role Plan administrator
Date 2020-07-31
Name of individual signing CHERRI BEDWELL
Role Employer/plan sponsor
Date 2020-07-31
Name of individual signing CHERRI BEDWELL

Agent

Name Role Address
STOKES, SEAN Agent 8535 GATEWOOD DRIVE NORTHMOBILE, AL 36619

Organizer

Name Role Address
STOKES, SEAN Organizer 8535 GATEWOOD DRIVE NORTHMOBILE, AL 36619
HYATT, DEBORAH DEAN Organizer 16486 JIM HADLEY ROADBAY MINETTE, AL 36507
WATERS, DARREN K Organizer 2350 SCHILLINGER ROAD S SUITE AMOBILE, AL 36695
PEARSON, STEVEN C Organizer P O BOX 290MOBILE, AL 36601

Related by officers

STOKES, SEAN

Wilmer Medical Clinic, LLC South Alabama Family Care LLC

HYATT, DEBORAH DEAN

Southwest Mobile Family Practice, LLC

WATERS, DARREN K

Sibling Rivalry, LLC GMUC OF CITRONELLE, LLC. Greater Mobile Urgent Care, P.C. GREATER MOBILE LASER AND AESTHETIC CENTER, P.C. Saraland MD Realty, LLC GMUC of Saraland, P.C. GMUC of Springhill, LLC Medical Alliance Group, Inc. GMUC of Tillmans Corner, P.C. ReHydrate, LLC

PEARSON, STEVEN C

Southwest Mobile Family Practice, LLC McElderry Properties, LLC Alans Grill LLC MOBILE PEDIATRIC CLINIC, LLC MJHD Investments, LLC DFI Construction of Mississippi, Inc. SHEPHERD'S PLACE FOUNDATION ISLANDERS RESTAURANT AND BAR, LLC Historic Murphy District Association, Inc. River Oaks Homeowners' Association, Inc.

Related by address

8535 GATEWOOD DRIVE NORTHMOBILE, AL 36619

DLS Grand Bay Properties, LLC

Date of last update: 30 Jul 2024

Sources: Alabama Secretary of State

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