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Sand Mountain Family Practice Center, P.C.

Details

Name: Sand Mountain Family Practice Center, P.C.
Jurisdiction: Alabama
Legal type: Domestic Professional Corporation
Status: Exists
Date of registration: 03 Jan 1978 (47 years ago) (Companies founded in January 1978)
Entity Number: 000-049-204
Register Number: 000049204
Historical Names: Sand Mountain Family Practice Center, P.A.
ZIP code: 35950 (Companies in Marshall, 35950)
County: Marshall
Place of Formation: Marshall County
Principal Address: ALBERTVILLE, AL
Registered Office Street Address: HIGHWAY 431 SOUTHALBERTVILLE, AL 35950
Authorized Capital: $1,200

Activities MEDICINE

Unique Entity ID

Unique Entity ID Expiration Date Physical Address Mailing Address
UMS2GNKKJRN5 2024-10-01 5104 US HIGHWAY 431, ALBERTVILLE, AL, 35950, 0237, USA 5104 US HIGHWAY 431, ALBERTVILLE, AL, 35950, 0237, USA

Business Information
Division Name SAND MOUNTAIN FAMILY PRACTICE CENTER, PC
Congressional District 04
State/Country of Incorporation AL, USA
Activation Date 2023-10-02
Initial Registration Date 2022-08-01
Entity Start Date 1978-10-01
Fiscal Year End Close Date Jun 30

Points of Contacts
Electronic Business
Title PRIMARY POC
Name LAURA L YOUNG
Role BOOKKEEPER
Address 5104 US HIGHWAY 431, ALBERTVILLE, AL, 35950, USA
Title ALTERNATE POC
Name ASHLEY DUCKETT
Role ACCOUNTS PAYABLE
Address 5104 US HIGHWAY 431, ALBERTVILLE, AL, 35950, USA
Government Business
Title PRIMARY POC
Name LAURA L YOUNG
Role BOOKKEEPER
Address 5104 US HIGHWAY 431, ALBERTVILLE, AL, 35950, USA
Title ALTERNATE POC
Name ASHLEY DUCKETT
Role OFFICE MANAGER
Address 5104 US HIGHWAY 431, ALBERTVILLE, AL, 35950, USA
Past Performance
Title ALTERNATE POC
Name ASHLEY DUCKETT
Role ACCOUNTS PAYABLE
Address 5104 US HIGHWAY 431, ALBERTVILLE, AL, 35950, USA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1255349346 2006-08-04 2008-04-20 5104 US HIGHWAY 431, ALBERTVILLE, AL, 359500237, US 5104 US HIGHWAY 431, ALBERTVILLE, AL, 359500237, US

Contacts
Phone +1 256-878-8180
Fax 2568913693

Authorized person
Name DR. MICHAEL WAYNE PETERS
Role PRESIDENT
Phone 2568788186

Taxonomy
Taxonomy Code 207Q00000X - Family Medicine Physician
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
SAND MOUNTAIN FAMILY PRACTICE CENTER, P.C. PROFIT SHARING PLAN 2022 630740093 2023-12-20 SAND MOUNTAIN FAMILY PRACTICE CENTER, P.C. 25
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1978-07-01
Business code 621111
Sponsor’s telephone number 2568788184
Plan sponsor’s address 5104 HIGHWAY 431 SOUTH, ALBERTVILLE, AL, 35950

Signature of
Role Plan administrator
Date 2023-12-20
Name of individual signing DENISE WALDEN
SAND MOUNTAIN FAMILY PRACTICE CENTER PC 401(K) PROFIT SHARING PLAN 2021 630740093 2022-10-12 SAND MOUNTAIN FAMILY PRACTICE CENTER 28
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1978-07-01
Business code 621111
Sponsor’s telephone number 2568788184
Plan sponsor’s address 5104 HIGHWAY 431 SOUTH, ALBERTVILLE, AL, 35950

Signature of
Role Plan administrator
Date 2022-10-12
Name of individual signing DENISE WALDEN
SAND MOUNTAIN FAMILY PRACTICE CENTER PC 401(K) PROFIT SHARING PLAN 2019 630740093 2020-09-17 SAND MOUNTAIN FAMILY PRACTICE CENTER 31
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1978-07-01
Business code 621111
Sponsor’s telephone number 2568788184
Plan sponsor’s address 5104 HIGHWAY 431 SOUTH, ALBERTVILLE, AL, 35950

Signature of
Role Plan administrator
Date 2020-09-17
Name of individual signing MICHAEL PETERS
SAND MOUNTAIN FAMILY PRACTICE CENTER PC 401(K) PROFIT SHARING PLAN 2018 630740093 2019-09-30 SAND MOUNTAIN FAMILY PRACTICE CENTER 30
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1978-07-01
Business code 621111
Sponsor’s telephone number 2568788184
Plan sponsor’s address 5104 HIGHWAY 431 SOUTH, ALBERTVILLE, AL, 35950

Signature of
Role Plan administrator
Date 2019-09-30
Name of individual signing MICHAEL PETERS
SAND MOUNTAIN FAMILY PRACTICE CENTER PC 401(K) PROFIT SHARING PLAN 2017 630740093 2018-09-19 SAND MOUNTAIN FAMILY PRACTICE CENTER 32
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1978-07-01
Business code 621111
Sponsor’s telephone number 2568788184
Plan sponsor’s address 5104 HIGHWAY 431 SOUTH, ALBERTVILLE, AL, 35950

Signature of
Role Plan administrator
Date 2018-09-19
Name of individual signing MICHAEL PETERS
SAND MOUNTAIN FAMILY PRACTICE CENTER PC 401(K) PROFIT SHARING PLAN 2016 630740093 2017-08-23 SAND MOUNTAIN FAMILY PRACTICE CENTER 29
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1978-07-01
Business code 621111
Sponsor’s telephone number 2568788184
Plan sponsor’s address 5104 HIGHWAY 431 SOUTH, ALBERTVILLE, AL, 35950

Signature of
Role Plan administrator
Date 2017-08-23
Name of individual signing MICHAEL PETERS
SAND MOUNTAIN FAMILY PRACTICE CENTER PC 401(K) PROFIT SHARING PLAN 2015 630740093 2016-09-14 SAND MOUNTAIN FAMILY PRACTICE CENTER 28
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1978-07-01
Business code 621111
Sponsor’s telephone number 2568788184
Plan sponsor’s address 5104 HIGHWAY 431 SOUTH, ALBERTVILLE, AL, 35950

Signature of
Role Plan administrator
Date 2016-09-14
Name of individual signing MICHAEL PETERS
SAND MOUNTAIN FAMILY PRACTICE CENTER PC 401(K) PROFIT SHARING PLAN 2014 630740093 2015-09-21 SAND MOUNTAIN FAMILY PRACTICE CENTER 29
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1978-07-01
Business code 621111
Sponsor’s telephone number 2568788184
Plan sponsor’s address 5104 HIGHWAY 431 SOUTH, ALBERTVILLE, AL, 35950

Signature of
Role Plan administrator
Date 2015-09-21
Name of individual signing MICHAEL PETERS
SAND MOUNTAIN FAMILY PRACTICE CENTER PC 401(K) PROFIT SHARING PLAN 2013 630740093 2015-01-09 SAND MOUNTAIN FAMILY PRACTICE CENTER 32
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1978-07-01
Business code 621111
Sponsor’s telephone number 2058788184
Plan sponsor’s address HIGHWAY 431 SOUTH, ALBERTVILLE, AL, 35950

Signature of
Role Plan administrator
Date 2015-01-09
Name of individual signing MICHAEL PETERS
SAND MOUNTAIN FAMILY PRACTICE CENTER PC 401(K) PROFIT SHARING PLAN 2012 630740093 2014-01-24 SAND MOUNTAIN FAMILY PRACTICE CENTER 32
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1978-07-01
Business code 621111
Sponsor’s telephone number 2058788184
Plan sponsor’s address HIGHWAY 431 SOUTH, ALBERTVILLE, AL, 35950

Signature of
Role Plan administrator
Date 2014-01-24
Name of individual signing MICHAEL PETERS

Agent

Name Role
BELYEU, JOHN M MD Agent

Incorporator

Name Role
PETERS, M WAYNE MD Incorporator
RATCLIFFE, A A JR MD Incorporator
BELYEU, JOHN M MD Incorporator

Events

Event Date Event Type Old Value New Value
1985-05-24 Name Change Sand Mountain Family Practice Center, P.A. Sand Mountain Family Practice Center, P.C.

Related by officers

No related officers

Related by address

ALBERTVILLE, AL

Albertville Quick Freeze, Inc. Albertville Roofing and Supply Co. Inc. B. & G. Supply Company J. D. Chandler Cycle Company Tom Barkley Ford, Inc. Petroleum Suppliers, Inc. Corbin's Furniture & Appliance Dendy's, Inc. Sparetime Lanes of Albertville, Inc. Dickson Parker Sales Service, Inc.

HIGHWAY 431 SOUTHALBERTVILLE, AL 35950

Global Custom Vans, Inc. Cleburn Oliver Enterprises, Inc. Ray Lemaster Motors, Inc. E. T. Holsonback Motors, Inc., a close corporation Hinton Mitchem Tractor Co., Inc. Edgewood Properties, Inc. Heritage Memorial Park, Inc.

Date of last update: 30 Jul 2024

Sources: Alabama Secretary of State

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