| Name: | Surgical Association of Mobile, P.A. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Association |
| Status: | Exists |
| Date of registration: | 04 Dec 1973 (51 years ago) |
| Entity Number: | 000-032-792 |
| Register Number: | 000032792 |
| County: | Mobile |
| Place of Formation: | Mobile County |
| Principal Address: | 3 MOBILE INFIRMARY CIRCLE STE 212MOBILE, AL 36607 |
| Principal Address ZIP Code: | 36607 |
| Unique Entity ID | Expiration Date | Physical Address | Mailing Address | |||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| CHMFG2KLDRV9 | 2025-04-11 | 3 MOBILE INFIRMARY CIR STE 212, MOBILE, AL, 36607, 3514, USA | 3 MOBILE INFIRMARY CIRCLE, SUITE 212, MOBILE, AL, 36607, 3520, USA | |||||||||||||||||||||||||||||||||||||||
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| Congressional District | 01 |
| State/Country of Incorporation | AL, USA |
| Activation Date | 2024-04-15 |
| Initial Registration Date | 2020-10-15 |
| Entity Start Date | 1973-12-03 |
| Fiscal Year End Close Date | Dec 31 |
Points of Contacts
| Electronic Business | |
|---|---|
| Title | PRIMARY POC |
| Name | ROBIN F REYNOLDS |
| Role | OFFICE MANAGER |
| Address | 3 MOBILE INFIRMARY CIRCLE, SUITE 212, MOBILE, AL, 36607, 3520, USA |
| Government Business | |
|---|---|
| Title | PRIMARY POC |
| Name | ROBIN F REYNOLDS |
| Role | OFFICE MANAGER |
| Address | 3 MOBILE INFIRMARY CIRCLE, SUITE 212, MOBILE, AL, 36607, 3520, USA |
| Past Performance | Information not Available |
|---|
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1285731729 | 2006-09-19 | 2012-08-24 | 3 MOBILE INFIRMARY CIRCLE, SUITE 212, MOBILE, AL, 36607, US | 3 MOBILE INFIRMARY CIRCLE, SUITE 212, MOBILE, AL, 36607, US | |||||||||||||||||||||||
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| Phone | +1 251-433-2609 |
| Fax | 2514389607 |
Authorized person
| Name | DR. JEFFREY K HANNON |
| Role | VICE PRESIDENT |
| Phone | 2514332609 |
Taxonomy
| Taxonomy Code | 208600000X - Surgery Physician |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 528902590 |
| State | AL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SURGICAL ASSOCIATION OF MOBILE, P.A. 401(K) PROFIT SHARING PLAN | 2023 | 630657778 | 2024-07-02 | SURGICAL ASSOCIATION OF MOBILE, P.A. | 37 | |||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2024-07-02 |
| Name of individual signing | JEFFREY K. HANNON |
| Name | Role | Address |
|---|---|---|
| HANNON, JEFFREY K | Member | 3 MOBILE INFIRMARY CIRCLE STE 212MOBILE, AL 36607 |
| LANE, DANIEL R | Member | 3 MOBILE INFIRMARY CIRCLE STE 212MOBILE, AL 36607 |
| RINGOLD, FORREST G | Member | 3 MOBILE INFIRMARY CIRCLE STE 212MOBILE, AL 36607 |
| SMITH, DUSTY F | Member | 8068 HOLLEY COURTDAPHNE, AL 36526 |
| BALLARD, BARRY D | Member | 3 MOBILE INFIRMARY CIRCLE STE 212MOBILE, AL 36607 |
| QUATRINO, GREGORY MARK | Member | 3 MOBILE INFIRMARY CIRCLE STE 212MOBILE, AL 36607 |
Date of last update: 30 Jul 2024
Sources: Alabama Secretary of State
