Dothan Surgical Services, LLC

Details

Name:	Dothan Surgical Services, LLC
Jurisdiction:	Alabama
Legal type:	Domestic Limited Liability Company
Status:	Dissolved
Date of registration:	30 Jun 2011 (13 years ago)
Date of dissolution:	21 Dec 2015
Entity Number:	000-018-240
Register Number:	000018240
County:	Houston
Place of Formation:	Houston County
Registered Office Street Address:	3208 ALDERBROOK DRIVEDOTHAN, AL 36301
Registered Office Street Address ZIP Code:	36301

Activities GENERAL SURGERY

National Provider Identifier

NPI

Enumeration Date

Last Update Date

Mailing Address

Practice Location Address

1932497393

2011-07-19

2011-07-19

4300 W MAIN ST, DOTHAN, AL, 363051054, US

4300 W MAIN ST, DOTHAN, AL, 363051054, US

Contacts

Phone	+1 334-699-7900
Fax	3346997901

Authorized person

Name	DR. JASON D BEAVER
Role	PHYSICIAN/ OWNER
Phone	3346997900

Taxonomy

Taxonomy Code	208600000X - Surgery Physician
License Number	21102
State	AL
Is Primary	Yes

form 5500

Plan Name

Plan Year

EIN/PN

Received

Sponsor

Total number of participants

DOTHAN SURGICAL SERVICES, LLC PROFIT SHARING PLAN

2014

452683508

2015-11-30

DOTHAN SURGICAL SERVICES, LLC

4

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2011-01-01
Business code	621498
Sponsor’s telephone number	3346185764
Plan sponsor’s address	3208 ALDERBROOK DRIVE, DOTHAN, AL, 36301

Signature of

Role	Plan administrator
Date	2015-11-30
Name of individual signing	JASON D. BEAVER, M.D.

DOTHAN SURGICAL SERVICES, LLC PROFIT SHARING PLAN

2014

452683508

2015-06-30

DOTHAN SURGICAL SERVICES, LLC

4

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2011-01-01
Business code	621498
Sponsor’s telephone number	3346185764
Plan sponsor’s address	3208 ALDERBROOK DRIVE, DOTHAN, AL, 36301

Signature of

Role	Plan administrator
Date	2015-06-30
Name of individual signing	JASON D. BEAVER, M.D.

DOTHAN SURGICAL SERVICES, LLC PROFIT SHARING PLAN

2013

452683508

2014-07-29

DOTHAN SURGICAL SERVICES, LLC

4

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2011-01-01
Business code	621498
Sponsor’s telephone number	3346185764
Plan sponsor’s address	3208 ALDERBROOK DRIVE, DOTHAN, AL, 36301

Signature of

Role	Plan administrator
Date	2014-07-29
Name of individual signing	JASON D. BEAVER, M.D.

DOTHAN SURGICAL SERVICES, LLC PROFIT SHARING PLAN

2012

452683508

2013-06-17

DOTHAN SURGICAL SERVICES, LLC

4

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2011-01-01
Business code	621498
Sponsor’s telephone number	3346185764
Plan sponsor’s address	3208 ALDERBROOK DRIVE, DOTHAN, AL, 36301

Signature of

Role	Plan administrator
Date	2013-06-17
Name of individual signing	JASON D. BEAVER, M.D.

DOTHAN SURGICAL SERVICES, LLC PROFIT SHARING PLAN

2011

452683508

2012-06-14

DOTHAN SURGICAL SERVICES, LLC

0

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2011-01-01
Business code	621498
Sponsor’s telephone number	3346185764
Plan sponsor’s address	3208 ALDERBROOK DRIVE, DOTHAN, AL, 36301

Plan administrator’s name and address

Administrator’s EIN	452683508
Plan administrator’s name	DOTHAN SURGICAL SERVICES, LLC
Plan administrator’s address	3208 ALDERBROOK DRIVE, DOTHAN, AL, 36301
Administrator’s telephone number	3346185764

Signature of

Role	Plan administrator
Date	2012-06-14
Name of individual signing	JASON D. BEAVER, M.D.

Agent

Name	Role
BEAVER, JASON D	Agent

Date of last update: 30 Jul 2024

Sources: Alabama Secretary of State