| Name: | Arthritis Care of the Eastern Shore, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 17 Aug 2011 (13 years ago) (Companies founded in August 2011) |
| Entity Number: | 000-023-607 |
| Register Number: | 000023607 |
| ZIP code: | 36532 (Companies in Baldwin, 36532) |
| County: | Baldwin |
| Place of Formation: | Baldwin County |
| Registered Office Street Address: | 3 MEDICAL PARKFAIRHOPE, AL 36532 |
Activities
PROFESSIONAL MEDICAL CARE IN THE DIAGNOSIS/TREATMENT OF DISEASE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1972885945 | 2011-09-15 | 2011-09-15 | 3 MEDICAL PARK, FAIRHOPE, AL, 365321804, US | 3 MEDICAL PARK, FAIRHOPE, AL, 365321804, US | |||||||||||||||||||||||||
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| Phone | +1 251-928-8804 |
| Fax | 2519293067 |
Authorized person
| Name | WILLIAM F SULLIVAN |
| Role | OWNER |
| Phone | 2519288804 |
Taxonomy
| Taxonomy Code | 207RR0500X - Rheumatology Physician |
| License Number | 12259 |
| State | AK |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 000023997 |
| State | AL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ARTHRITIS CARE OF THE EASTERN SHORE, LLC 401(K) PLAN | 2023 | 453027041 | 2024-10-11 | ARTHRITIS CARE OF THE EASTERN SHORE, LLC | 2 | |||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2024-10-11 |
| Name of individual signing | WILLIAM F. SULLIVAN, M.D. |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2021-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 2519288804 |
| Plan sponsor’s address | 3 MEDICAL PARK, FAIRHOPE, AL, 36532 |
Signature of
| Role | Plan administrator |
| Date | 2023-09-05 |
| Name of individual signing | WILLIAM SULLIVAN |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2021-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 2519288804 |
| Plan sponsor’s address | 3 MEDICAL PARK, FAIRHOPE, AL, 36532 |
| Name | Role | Address |
|---|---|---|
| SULLIVAN, WILLIAM F | Agent | 3 MEDICAL PARKFAIRHOPE, AL 36532 |
| Name | Role | Address |
|---|---|---|
| SULLIVAN, WILLIAM F | Organizer | 3 MEDICAL PARKFAIRHOPE, AL 36532 |
Date of last update: 30 Jul 2024
Sources: Alabama Secretary of State
