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Isbell Medical Group, P.C.

Details

Name: Isbell Medical Group, P.C.
Jurisdiction: Alabama
Legal type: Domestic Professional Corporation
Status: Exists
Date of registration: 01 Oct 1972 (52 years ago)
Entity Number: 000-036-310
Register Number: 000036310
Historical Names: Isbell Clinic
County: De Kalb
Place of Formation: DeKalb County
Registered Office Street Address: 550 MEDICAL CENTER DR SWFORT PAYNE, AL 35968
Registered Office Street Address ZIP Code: 35968
Principal Address: 317 MEDICAL CENTER DRIVEFORT PAYNE, AL 35967
Principal Address ZIP Code: 35967
Authorized Capital: $100

Activities PRACTICE OF MEDICINE

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1457411043 2006-12-12 2018-01-17 550 MEDICAL CENTER DR SW, PO BOX 680199, FORT PAYNE, AL, 359683418, US 550 MEDICAL CENTER DR SW, FORT PAYNE, AL, 359683418, US

Contacts
Phone +1 256-845-8885
Fax 2568459546

Authorized person
Name DR. JOHN BLAKELY ISBELL
Role PRESIDENT
Phone 2568458885

Taxonomy
Taxonomy Code 261QM1300X - Multi-Specialty Clinic/Center
Is Primary Yes
Taxonomy Code 261QR1300X - Rural Health Clinic/Center
Is Primary No

Other Provider Identifiers
Issuer MEDICAID
Number 528301650
State AL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
ISBELL MEDICAL GROUP 401(K) PROFIT SHARING PLAN 2023 630636324 2024-06-23 ISBELL MEDICAL GROUP 43
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1985-10-01
Business code 621111
Sponsor’s telephone number 2568458885
Plan sponsor’s address 550 MEDICAL CENTER DR SW, FORT PAYNE, AL, 35968

Signature of
Role Plan administrator
Date 2024-06-23
Name of individual signing TAMERA BEARDEN
ISBELL MEDICAL GROUP 401(K) PROFIT SHARING PLAN 2022 630636324 2023-09-12 ISBELL MEDICAL GROUP 43
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1985-10-01
Business code 621111
Sponsor’s telephone number 2568458885
Plan sponsor’s address 550 MEDICAL CENTER DR SW, FORT PAYNE, AL, 35968

Signature of
Role Plan administrator
Date 2023-09-12
Name of individual signing TAMERA BEARDEN
ISBELL MEDICAL GROUP 401(K) PROFIT SHARING PLAN 2021 630636324 2022-07-17 ISBELL MEDICAL GROUP 47
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1985-10-01
Business code 621111
Sponsor’s telephone number 2568458885
Plan sponsor’s address 550 MEDICAL CENTER DR SW, FORT PAYNE, AL, 35968

Signature of
Role Plan administrator
Date 2022-07-17
Name of individual signing TAMERA BEARDEN
ISBELL MEDICAL GROUP 401(K) PROFIT SHARING PLAN 2020 630636324 2021-09-19 ISBELL MEDICAL GROUP 45
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1985-10-01
Business code 621111
Sponsor’s telephone number 2568458885
Plan sponsor’s address 550 MEDICAL CENTER DR SW, FORT PAYNE, AL, 35968

Signature of
Role Plan administrator
Date 2021-09-19
Name of individual signing TAMERA BEARDEN
ISBELL MEDICAL GROUP 401(K) PROFIT SHARING PLAN 2019 630636324 2020-07-26 ISBELL MEDICAL GROUP 40
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1985-10-01
Business code 621111
Sponsor’s telephone number 2568458885
Plan sponsor’s address 550 MEDICAL CENTER DR SW, FORT PAYNE, AL, 35968

Signature of
Role Plan administrator
Date 2020-07-26
Name of individual signing TAMERA BEARDEN
ISBELL MEDICAL GROUP 401(K) PROFIT SHARING PLAN 2018 630636324 2019-07-06 ISBELL MEDICAL GROUP 42
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1985-10-01
Business code 621111
Sponsor’s telephone number 2568458885
Plan sponsor’s address 550 MEDICAL CENTER DR SW, FORT PAYNE, AL, 35968

Signature of
Role Plan administrator
Date 2019-07-06
Name of individual signing TAMERA BEARDEN
ISBELL MEDICAL GROUP 401(K) PROFIT SHARING PLAN 2017 630636324 2018-09-03 ISBELL MEDICAL GROUP 42
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1985-10-01
Business code 621111
Sponsor’s telephone number 2568458885
Plan sponsor’s address 550 MEDICAL CENTER DR SW, FORT PAYNE, AL, 35968

Signature of
Role Plan administrator
Date 2018-09-03
Name of individual signing TAMERA BEARDEN
ISBELL MEDICAL GROUP 401(K) PROFIT SHARING PLAN 2016 630636324 2017-08-08 ISBELL MEDICAL GROUP 45
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1985-10-01
Business code 621111
Sponsor’s telephone number 2568458885
Plan sponsor’s address 550 MEDICAL CENTER DR SW, FORT PAYNE, AL, 35968

Signature of
Role Plan administrator
Date 2017-08-08
Name of individual signing TAMERA BEARDEN
ISBELL MEDICAL GROUP 401(K) PROFIT SHARING PLAN 2015 630636324 2016-08-29 ISBELL MEDICAL GROUP 45
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1985-10-01
Business code 621111
Sponsor’s telephone number 2568458885
Plan sponsor’s address 550 MEDICAL CENTER DR SW, FORT PAYNE, AL, 35968

Signature of
Role Plan administrator
Date 2016-08-29
Name of individual signing TAMERA BEARDEN
ISBELL MEDICAL GROUP 401(K) PROFIT SHARING PLAN 2014 630636324 2015-07-02 ISBELL MEDICAL GROUP 47
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1985-10-01
Business code 621111
Sponsor’s telephone number 2568458885
Plan sponsor’s address 550 MEDICAL CENTER DR SW, FORT PAYNE, AL, 35968

Signature of
Role Plan administrator
Date 2015-07-02
Name of individual signing TAMERA BEARDEN

Incorporator

Name Role
ISBELL, CHARLES A Incorporator
ISBELL, JOHN B III Incorporator

Agent

Name Role
ISBELL, JOHN BLAKELY Agent

Events

Event Date Event Type Old Value New Value
1999-05-24 Name Change Isbell Clinic Isbell Medical Group, P.C.
1999-05-24 Capital Change --- Authorized --- Paid In $100 Authorized undefined Paid In

Related by officers

ISBELL, CHARLES A

Willow Springs, Inc.

Related by address

550 MEDICAL CENTER DR SWFORT PAYNE, AL 35968

Northeast Alabama Health Care, L.C.C.

317 MEDICAL CENTER DRIVEFORT PAYNE, AL 35967

Northeast Alabama Health Care, L.C.C.

Date of last update: 30 Jul 2024

Sources: Alabama Secretary of State

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