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Cullman Urology, P.C.

Details

Name: Cullman Urology, P.C.
Jurisdiction: Alabama
Legal type: Domestic Professional Corporation
Status: Dissolved
Date of registration: 05 May 1977 (47 years ago)
Date of dissolution: 20 Dec 2022
Entity Number: 000-045-993
Register Number: 000045993
Historical Names: Cullman Urology, P.A.
County: Cullman
Place of Formation: Cullman County
Principal Address: CULLMAN, AL
Registered Office Street Address: 1848 PARKLAND DRIVE NECULLMAN, AL 35055
Registered Office Street Address ZIP Code: 35055
Authorized Capital: $5,000

Activities MEDICINE

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1275595183 2006-04-05 2013-05-01 1848 PARKLAND DRIVE NE, CULLMAN, AL, 35058, US 1848 PARKLAND DRIVE NE, CULLMAN, AL, 35058, US

Contacts

Phone +1 256-739-2885
Fax 2567392898

Authorized person

Name MS. DENISE GILLEY
Role OFFICE MANAGER
Phone 2567392885

Taxonomy

Taxonomy Code 208800000X - Urology Physician
Is Primary Yes

Other Provider Identifiers

Issuer MEDICAID
Number 529302990
State AL
Issuer BC-BS OF ALABAMA GROUP #
Number D472
State AL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
CULLMAN UROLOGY, P.A. 401(K) PROFIT SHARING PLAN 2013 630725909 2014-07-24 CULLMAN UROLOGY, P.A. 13
File View Page
Three-digit plan number (PN) 003
Effective date of plan 1994-01-01
Business code 621111
Sponsor’s telephone number 2567392885
Plan sponsor’s address 1848 PARKLAND DRIVE N.E., CULLMAN, AL, 35058

Signature of

Role Plan administrator
Date 2014-07-24
Name of individual signing JAMES W. DAVIS
CULLMAN UROLOGY, P.A. 401(K) PROFIT SHARING PLAN 2009 630725909 2010-07-27 CULLMAN UROLOGY, P.A. 12
File View Page
Three-digit plan number (PN) 003
Effective date of plan 1994-01-01
Business code 621111
Sponsor’s telephone number 2567392885
Plan sponsor’s address 1948 ALABAMA HWY 157, STE 450, CULLMAN, AL, 35055

Plan administrator’s name and address

Administrator’s EIN 630725909
Plan administrator’s name CULLMAN UROLOGY, P.A.
Plan administrator’s address 1948 ALABAMA HWY 157, STE 450, CULLMAN, AL, 35055
Administrator’s telephone number 2567392885

Signature of

Role Plan administrator
Date 2010-07-27
Name of individual signing JAMES W. DAVIS

Agent

Name Role Address
SANDERS, RODNEY Agent 25159 THACH ROADATHENS, AL 35613

Incorporator

Name Role
DAVIS, JAMES W MD Incorporator
PARKER, WILLIAM MD Incorporator

Events

Event Date Event Type Old Value New Value
1984-05-29 Name Change Cullman Urology, P.A. Cullman Urology, P.C.

Date of last update: 30 Jul 2024

Sources: Alabama Secretary of State