| Name: | Princeton Pulmonary Group, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Dissolved |
| Date of registration: | 03 Jul 1978 (46 years ago) |
| Date of dissolution: | 27 Jun 2018 |
| Entity Number: | 000-052-063 |
| Register Number: | 000052063 |
| County: | Jefferson |
| Place of Formation: | Jefferson County |
| Principal Address: | BIRMINGHAM, AL |
| Registered Office Street Address: | 817 PRINCETON AVE SW STE 115BIRMINGHAM, AL 35211 |
| Registered Office Street Address ZIP Code: | 35211 |
| Authorized Capital: | $5,000 |
| Paid Share Capital: | $1,000 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1518075092 | 2006-08-26 | 2007-11-21 | 817 PRINCETON AVE SW, STE 115, BIRMINGHAM, AL, 352111333, US | 817 PRINCETON AVE SW, STE 115, BIRMINGHAM, AL, 352111333, US | |||||||||||||||||||||||||||||||
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| Phone | +1 205-780-1963 |
| Fax | 2057802345 |
Authorized person
| Name | MARCHELLE CAGLE |
| Role | MANAGER |
| Phone | 2057885533 |
Taxonomy
| Taxonomy Code | 207RC0200X - Critical Care Medicine (Internal Medicine) Physician |
| Is Primary | No |
| Taxonomy Code | 207RP1001X - Pulmonary Disease Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | RAILROAD MEDICARE GROUP # |
| Number | CL1358 |
| State | AL |
| Issuer | RAILROAD MEDICARE GROUP # |
| Number | CM7930 |
| State | AL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| PRINCETON PULMONARY GROUP, P.C. 401(K) PROFIT SHARING PLAN | 2011 | 630751372 | 2012-07-30 | PRINCETON PULMONARY GROUP, P.C. | 23 | |||||||||||||||||||||||||||||
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| Administrator’s EIN | 630751372 |
| Plan administrator’s name | PRINCETON PULMONARY GROUP, P.C. |
| Plan administrator’s address | 817 PRINCETON AVE, SUITE 115, BIRMINGHAM, AL, 35211 |
| Administrator’s telephone number | 5027801963 |
Signature of
| Role | Plan administrator |
| Date | 2012-07-30 |
| Name of individual signing | JAMES H. LOTT III |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2009-07-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 5027801963 |
| Plan sponsor’s address | 817 PRINCETON AVE, SUITE 115, BIRMINGHAM, AL, 35211 |
Plan administrator’s name and address
| Administrator’s EIN | 630751372 |
| Plan administrator’s name | PRINCETON PULMONARY GROUP, P.C. |
| Plan administrator’s address | 817 PRINCETON AVE, SUITE 115, BIRMINGHAM, AL, 35211 |
| Administrator’s telephone number | 5027801963 |
Signature of
| Role | Plan administrator |
| Date | 2012-01-26 |
| Name of individual signing | JAMES H. LOTT III |
| Name | Role |
|---|---|
| RUSSAKOFF, A DAVID | Incorporator |
| HASSON, JACK H MD | Incorporator |
| Name | Role |
|---|---|
| HASSON, JACK H MD | Agent |
Date of last update: 31 Jul 2024
Sources: Alabama Secretary of State
