| Name: | Psychological Medicine, P.A. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Association |
| Status: | Dissolved |
| Date of registration: | 10 Mar 1982 (43 years ago) |
| Date of dissolution: | 11 Feb 2016 |
| Entity Number: | 000-039-237 |
| Register Number: | 000039237 |
| County: | Houston |
| Place of Formation: | Houston County |
| Principal Address: | 700 ROYAL PKWYDOTHAN, AL 36305 |
| Principal Address ZIP Code: | 36305 |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| PSYCHOLOGICAL MEDICINE, P.A. PROFIT SHARING PLAN | 2010 | 630696265 | 2011-12-06 | PSYCHOLOGICAL MEDICINE, P.A. | 1 | |||||||||||||||||||||||||||||||||||||
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| Administrator’s EIN | 630696265 |
| Plan administrator’s name | PSYCHOLOGICAL MEDICINE, P.A. |
| Plan administrator’s address | 700 ROYAL PARKWAY, DOTHAN, AL, 36305 |
| Administrator’s telephone number | 3347922828 |
Signature of
| Role | Plan administrator |
| Date | 2011-12-06 |
| Name of individual signing | FERNANDO LOPEZ, MD |
| Role | Employer/plan sponsor |
| Date | 2011-12-06 |
| Name of individual signing | FERNANDO LOPEZ, MD |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 1975-11-12 |
| Business code | 621112 |
| Sponsor’s telephone number | 3347922828 |
| Plan sponsor’s address | 700 ROYAL PARKWAY, DOTHAN, AL, 36305 |
Plan administrator’s name and address
| Administrator’s EIN | 630696265 |
| Plan administrator’s name | PSYCHOLOGICAL MEDICINE, P.A. |
| Plan administrator’s address | 700 ROYAL PARKWAY, DOTHAN, AL, 36305 |
| Administrator’s telephone number | 3347922828 |
Signature of
| Role | Plan administrator |
| Date | 2010-12-20 |
| Name of individual signing | FERNANDO LOPEZ, MD |
| Role | Employer/plan sponsor |
| Date | 2010-12-20 |
| Name of individual signing | FERNANDO LOPEZ, MD |
| Name | Role | Address |
|---|---|---|
| LOPEZ, FERNANDO | Member | 700 ROYAL PKWYDOTHAN, AL 36305 |
Date of last update: 30 Jul 2024
Sources: Alabama Secretary of State
