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PELL CITY INTERNAL AND FAMILY MEDICINE, LLC

Details

Name: PELL CITY INTERNAL AND FAMILY MEDICINE, LLC
Jurisdiction: Alabama
Legal type: Domestic Limited Liability Company
Status: Exists
Date of registration: 31 Jan 2012 (13 years ago) (Companies founded in January 2012)
Entity Number: 000-040-574
Register Number: 000040574
Historical Names: PELL CITY INTERNAL MEDICINE, LLC
ZIP code: 35125 (Companies in Saint Clair, 35125)
County: Saint Clair
Place of Formation: Saint Clair County
Registered Office Street Address: 7067 VETERANS PARKWAY, SUITE 130PELL CITY, AL 35125

Activities DIAGNOSTIC/TREATMENT SERVICES/PREVENTATIVE CARE

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1649539610 2012-05-11 2022-02-15 41 EMINENCE WAY STE A, PELL CITY, AL, 351282338, US 41 EMINENCE WAY STE A, PELL CITY, AL, 351282338, US

Contacts
Phone +1 205-884-9000
Fax 2058848111

Authorized person
Name TERRI WOODS
Role OFFICE ADMINISTRATOR
Phone 2058849000

Taxonomy
Taxonomy Code 207Q00000X - Family Medicine Physician
License Number 27238
State AL
Is Primary Yes
Taxonomy Code 207R00000X - Internal Medicine Physician
License Number 22922
State AL
Is Primary No

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
PELL CITY INTERNAL & FAMILY MEDICINE RETIREMENT PLAN 2023 454294355 2024-05-08 PELL CITY INTERNAL AND FAMILY MEDICINE 39
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-01-01
Business code 621111
Sponsor’s telephone number 2058849000
Plan sponsor’s address 41 EMINENCE WAY, SUITE A, PELL CITY, AL, 35128

Signature of
Role Plan administrator
Date 2024-05-08
Name of individual signing TERRI WOODS
PELL CITY INTERNAL FAMILY MEDICINE LLC (WELFARE PLAN) 2023 454294355 2024-07-18 PELL CITY INTERNAL FAMILY MEDICINE 31
File View Page
Three-digit plan number (PN) 951
Effective date of plan 2021-01-01
Business code 621111
Sponsor’s telephone number 2052270485
Plan sponsor’s address 41 EMINENCE WAY STE A, PELL CITY, AL, 35128

Plan administrator’s name and address
Administrator’s EIN 472506773
Plan administrator’s name KENNION & CO LLC
Plan administrator’s address 2828 OLD 280 COURT STE 110, VESTAVIA, AL, 35243
Administrator’s telephone number 8669665457

Signature of
Role Plan administrator
Date 2024-06-18
Name of individual signing W. HAL SHEPHERD
Role Employer/plan sponsor
Date 2024-06-18
Name of individual signing W. HAL SHEPHERD
PELL CITY INTERNAL & FAMILY MEDICINE RETIREMENT PLAN 2022 454294355 2023-05-23 PELL CITY INTERNAL AND FAMILY MEDICINE 31
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-01-01
Business code 621111
Sponsor’s telephone number 2058849000
Plan sponsor’s address 41 EMINENCE WAY, SUITE A, PELL CITY, AL, 35128

Signature of
Role Plan administrator
Date 2023-05-23
Name of individual signing TERRI WOODS
PELL CITY INTERNAL FAMILY MEDICINE LLC (WELFARE PLAN) 2022 454294355 2023-07-27 PELL CITY INTERNAL FAMILY MEDICINE 31
File View Page
Three-digit plan number (PN) 951
Effective date of plan 2021-01-01
Business code 621111
Sponsor’s telephone number 2052270485
Plan sponsor’s address 41 EMINENCE WAY STE A, PELL CITY, AL, 35128

Plan administrator’s name and address
Administrator’s EIN 472506773
Plan administrator’s name KENNION & CO LLC
Plan administrator’s address 2828 OLD 280 COURT STE 110, VESTAVIA, AL, 35243
Administrator’s telephone number 8669665457

Signature of
Role Plan administrator
Date 2023-07-20
Name of individual signing W. HAL SHEPHERD
Role Employer/plan sponsor
Date 2023-07-20
Name of individual signing W. HAL SHEPHERD
PELL CITY INTERNAL FAMILY MEDICINE RETIREMENT 2021 454294355 2022-06-08 PELL CITY INTERNAL AND FAMILY MEDICINE 30
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-01-01
Business code 621111
Sponsor’s telephone number 2058849000
Plan sponsor’s address 41 EMINENCE WAY, SUITE A, PELL CITY, AL, 35128

Signature of
Role Plan administrator
Date 2022-06-08
Name of individual signing TERRI WOODS
Role Employer/plan sponsor
Date 2022-06-08
Name of individual signing TERRI WOODS
PELL CITY INTERNAL FAMILY MEDICINE LLC (WELFARE PLAN) 2021 454294355 2022-07-29 PELL CITY INTERNAL FAMILY MEDICINE 0
File View Page
Three-digit plan number (PN) 951
Effective date of plan 2021-01-01
Business code 621111
Sponsor’s telephone number 2052270485
Plan sponsor’s address 41 EMINENCE WAY STE A, PELL CITY, AL, 35128

Plan administrator’s name and address
Administrator’s EIN 472506773
Plan administrator’s name KENNION & CO LLC
Plan administrator’s address 2828 OLD 280 COURT STE 110, VESTAVIA, AL, 35243
Administrator’s telephone number 8669665457

Signature of
Role Plan administrator
Date 2022-07-27
Name of individual signing W. HAL SHEPHERD
Role Employer/plan sponsor
Date 2022-07-27
Name of individual signing W. HAL SHEPHERD
PELL CITY INTERNAL FAMILY MEDICINE RETIREMENT 2020 454294355 2021-06-15 PELL CITY INTERNAL AND FAMILY MEDICINE 30
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-01-01
Business code 621111
Sponsor’s telephone number 2058849000
Plan sponsor’s address 41 EMINENCE WAY, SUITE A, PELL CITY, AL, 35128

Signature of
Role Plan administrator
Date 2021-06-15
Name of individual signing TERRI WOODS
Role Employer/plan sponsor
Date 2021-06-15
Name of individual signing TERRI WOODS
PELL CITY INTERNAL FAMILY MEDICINE RETIREMENT 2019 454294355 2020-07-07 PELL CITY INTERNAL AND FAMILY MEDICINE 25
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-01-01
Business code 621111
Sponsor’s telephone number 2058849000
Plan sponsor’s address 7067 VETERANS PARKWAY, SUITE 200, PELL CITY, AL, 35125

Signature of
Role Plan administrator
Date 2020-07-07
Name of individual signing RUTWIJ K. JOTANI
PELL CITY INTERNAL FAMILY MEDICINE RETIREMENT 2018 454294355 2019-10-14 PELL CITY INTERNAL AND FAMILY MEDICINE 22
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-01-01
Business code 621111
Sponsor’s telephone number 2058849000
Plan sponsor’s address 7067 VETERANS PARKWAY, SUITE 200, PELL CITY, AL, 35125

Signature of
Role Plan administrator
Date 2019-10-14
Name of individual signing LEA ANN HOWARD
PELL CITY INTERNAL FAMILY MEDICINE RETIREMENT 2017 454294355 2018-07-18 PELL CITY INTERNAL AND FAMILY MEDICINE 20
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-01-01
Business code 621111
Sponsor’s telephone number 2058849000
Plan sponsor’s address 7067 VETERANS PARKWAY, SUITE 200, PELL CITY, AL, 35125

Signature of
Role Plan administrator
Date 2018-07-18
Name of individual signing RUTWIJ K. JOTANI

Agent

Name Role Address
COLLINS, BARRY Agent 125 JEFFREY WILSON DRIVEODENVILLE, AL 35120

Member

Name Role
PRISACRA, ILINCA Member

Organizer

Name Role Address
JOTANI, RUTWIJ Organizer 7067 VETERANS PARKWAY SUITE 200PELL CITY, AL 35125
COLLINS, BARRY Organizer 125 JEFFREY WILSON DRIVEODENVILLE, AL 35120

Events

Event Date Event Type Old Value New Value
2012-05-18 Name Change PELL CITY INTERNAL MEDICINE, LLC PELL CITY INTERNAL AND FAMILY MEDICINE, LLC

Related by officers

COLLINS, BARRY

The Pell City Police Foundation, Inc. Pell City Urgent Care and Family Medicine, LLC Margaret Medical Clinic, LLC

JOTANI, RUTWIJ

Prem-YSJ, LLC Pell City Urgent Care and Family Medicine, LLC Margaret Medical Clinic, LLC Eminence Health Partners, LLC

Related by address

No related companies by address

Date of last update: 30 Jul 2024

Sources: Alabama Secretary of State

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