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North Alabama OB-GYN Associates P.A.

Details

Name: North Alabama OB-GYN Associates P.A.
Jurisdiction: Alabama
Legal type: Domestic Professional Association
Status: Exists
Date of registration: 04 Jun 1971 (53 years ago)
Entity Number: 000-012-236
Register Number: 000012236
Historical Names: Drs. McCain and Thomas, P.A.
Drs. McCain, Thomas, & New, P.A.
McCain, Thomas, New & Manifold, P.A.
Decatur OB-GYN Associates, P.A.
County: Morgan
Place of Formation: Morgan County
Principal Address: 1304 13TH AVE SEDECATUR, AL 35601
Principal Address ZIP Code: 35601
Registered Office Street Address: 1041 BALCH ROAD, SUITE 250MADISON, AL 35758
Registered Office Street Address ZIP Code: 35758

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1912966847 2006-03-20 2023-10-26 1041 BALCH RD STE 250, MADISON, AL, 357588822, US 1041 BALCH RD STE 250, MADISON, AL, 357588822, US

Contacts
Phone +1 256-704-2229
Fax 2567042235

Authorized person
Name BETHEL RENFROW
Role OFFICE ADMINISTRATOR/NP
Phone 9126744657

Taxonomy
Taxonomy Code 207V00000X - Obstetrics & Gynecology Physician
License Number 14183
State AL
Is Primary Yes
Taxonomy Code 207V00000X - Obstetrics & Gynecology Physician
State AL
Is Primary No
Taxonomy Code 207V00000X - Obstetrics & Gynecology Physician
Is Primary No

Other Provider Identifiers
Issuer MEDICAID
Number 529100940
State AL
Issuer MEDICAID
Number 000087211
State AL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
DECATUR OB-GYN 401(K) PROFIT SHARING PLAN 2021 630597703 2022-10-05 DECATUR OB-GYN ASSOCIATES, P.A. 56
File View Page
Three-digit plan number (PN) 003
Effective date of plan 1992-01-01
Business code 621111
Sponsor’s telephone number 2563559711
Plan sponsor’s address 1304 13TH AVENUE, S.E., DECATUR, AL, 35601

Signature of
Role Plan administrator
Date 2022-10-05
Name of individual signing BETHEL RENFROW
DECATUR OB-GYN 401(K) PROFIT SHARING PLAN 2020 630597703 2021-09-16 DECATUR OB-GYN ASSOCIATES, P.A. 55
File View Page
Three-digit plan number (PN) 003
Effective date of plan 1992-01-01
Business code 621111
Sponsor’s telephone number 2563559711
Plan sponsor’s address 1304 13TH AVENUE, S.E., DECATUR, AL, 35601

Signature of
Role Plan administrator
Date 2021-09-16
Name of individual signing MARK PURVIS
DECATUR OB-GYN 401(K) PROFIT SHARING PLAN 2019 630597703 2020-10-08 DECATUR OB-GYN ASSOCIATES, P.A. 58
File View Page
Three-digit plan number (PN) 003
Effective date of plan 1992-01-01
Business code 621111
Sponsor’s telephone number 2563559711
Plan sponsor’s address 1304 13TH AVENUE, S.E., DECATUR, AL, 35601

Signature of
Role Plan administrator
Date 2020-10-08
Name of individual signing MARK PURVIS
DECATUR OB-GYN 401(K) PROFIT SHARING PLAN 2018 630597703 2019-10-09 DECATUR OB-GYN ASSOCIATES, P.A. 56
File View Page
Three-digit plan number (PN) 003
Effective date of plan 1992-01-01
Business code 621111
Sponsor’s telephone number 2563559711
Plan sponsor’s address 1874 BELTLINE ROAD, SUITE 105, DECATUR, AL, 35601

Signature of
Role Plan administrator
Date 2019-10-09
Name of individual signing MARK PURVIS
DECATUR OB-GYN 401(K) PROFIT SHARING PLAN 2017 630597703 2018-07-09 DECATUR OB-GYN ASSOCIATES, P.A. 52
File View Page
Three-digit plan number (PN) 003
Effective date of plan 1992-01-01
Business code 621111
Sponsor’s telephone number 2563559711
Plan sponsor’s address 1874 BELTLINE ROAD, SUITE 105, DECATUR, AL, 35601

Signature of
Role Plan administrator
Date 2018-07-09
Name of individual signing JOHN SHANNON
DECATUR OB-GYN 401(K) PROFIT SHARING PLAN 2016 630597703 2017-06-26 DECATUR OB-GYN ASSOCIATES, P.A. 47
File View Page
Three-digit plan number (PN) 003
Effective date of plan 1992-01-01
Business code 621111
Sponsor’s telephone number 2563559711
Plan sponsor’s address 1874 BELTLINE ROAD, SUITE 105, DECATUR, AL, 35601

Signature of
Role Plan administrator
Date 2017-06-26
Name of individual signing JOHN SHANNON
DECATUR OB-GYN 401(K) PROFIT SHARING PLAN 2015 630597703 2016-05-09 DECATUR OB-GYN ASSOCIATES, P.A. 40
File View Page
Three-digit plan number (PN) 003
Effective date of plan 1992-01-01
Business code 621111
Sponsor’s telephone number 2563559711
Plan sponsor’s address 1874 BELTLINE ROAD, SUITE 105, DECATUR, AL, 35601

Signature of
Role Plan administrator
Date 2016-05-09
Name of individual signing JOHN SHANNON
DECATUR OB-GYN 401(K) PROFIT SHARING PLAN 2014 630597703 2015-07-20 DECATUR OB-GYN ASSOCIATES, P.A. 30
File View Page
Three-digit plan number (PN) 003
Effective date of plan 1992-01-01
Business code 621111
Sponsor’s telephone number 2563559711
Plan sponsor’s address 1304 13TH AVENUE SE, DECATUR, AL, 35601

Signature of
Role Plan administrator
Date 2015-07-20
Name of individual signing JOHN SHANNON
Role Employer/plan sponsor
Date 2015-07-20
Name of individual signing JOHN SHANNON
DECATUR OB-GYN ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN 2013 630597703 2014-07-14 DECATUR OB-GYN ASSOCIATES, P.A. 32
File View Page
Three-digit plan number (PN) 003
Effective date of plan 1992-01-01
Business code 621111
Sponsor’s telephone number 2563559711
Plan sponsor’s address 1304 13TH AVENUE SE, DECATUR, AL, 35601

Signature of
Role Plan administrator
Date 2014-07-14
Name of individual signing JOHN SHANNON
DECATUR OB-GYN ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN 2012 630597703 2013-05-15 DECATUR OB-GYN ASSOCIATES, P.A. 33
File View Page
Three-digit plan number (PN) 003
Effective date of plan 1992-01-01
Business code 621111
Sponsor’s telephone number 2563559711
Plan sponsor’s address 1304 13TH AVENUE SE, DECATUR, AL, 35601

Signature of
Role Plan administrator
Date 2013-05-15
Name of individual signing JOHN SHANNON

Agent

Name Role
PURVIS, MARK T. Agent

Member

Name Role Address
THOMAS, F PHILLIP Member No data
MANIFOLD, G WILLIAM Member 2114 BROOKMEADE ROAD SEDECATUR, AL 35601
SHANNON, JOHN A Member No data

Events

Event Date Event Type Old Value New Value
2023-06-20 Name Change Decatur OB-GYN Associates, P.A. North Alabama OB-GYN Associates P.A.
1990-06-26 Name Change McCain, Thomas, New & Manifold, P.A. Decatur OB-GYN Associates, P.A.
1982-02-09 Name Change Drs. McCain, Thomas, & New, P.A. McCain, Thomas, New & Manifold, P.A.
1975-11-03 Name Change Drs. McCain and Thomas, P.A. Drs. McCain, Thomas, & New, P.A.

Related by officers

MANIFOLD, G WILLIAM

G. William Manifold, M.D,, P.C. MS Properties, L.L.C. B & D Properties, LLC

SHANNON, JOHN A

MS Properties, L.L.C. OB-GYN Associates Realty, L.L.C.

Related by address

1304 13TH AVE SEDECATUR, AL 35601

Creekwater Investment Group LLC

Date of last update: 30 Jul 2024

Sources: Alabama Secretary of State

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