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Luverne Health Clinic, P.A.

Details

Name: Luverne Health Clinic, P.A.
Jurisdiction: Alabama
Legal type: Domestic Professional Association
Status: Exists
Date of registration: 02 Dec 1980 (44 years ago)
Entity Number: 000-063-787
Register Number: 000063787
Place of Formation: Crenshaw County
Principal Address: ROY BEAL DRLUVERNE, AL 36409

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1659539435 2008-05-28 2008-05-28 PO BOX 407, LUVERNE, AL, 360490407, US 39 ROY BEALL DR, LUVERNE, AL, 360496805, US

Contacts
Phone +1 334-335-6515
Fax 3343352105

Authorized person
Name SAMUEL PATRICK WALKER
Role PRESIDENT
Phone 3343356515

Taxonomy
Taxonomy Code 174400000X - Specialist
License Number 6744
State AL
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 000006567
State AL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
LUVERNE HEALTH CLINIC, P.A. PROFIT SHARING PLAN 2021 630798719 2022-07-27 LUVERNE HEALTH CLINIC P A 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1982-01-01
Business code 621111
Sponsor’s telephone number 3343356515
Plan sponsor’s address PO BOX 407, LUVERNE, AL, 360490407

Signature of
Role Plan administrator
Date 2022-07-27
Name of individual signing SANDRA WALKER
Role Employer/plan sponsor
Date 2022-07-27
Name of individual signing SANDRA WALKER
LUVERNE HEALTH CLINIC, P.A. PROFIT SHARING PLAN 2020 630798719 2022-07-27 LUVERNE HEALTH CLINIC P A 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1982-01-01
Business code 621111
Sponsor’s telephone number 3343356515
Plan sponsor’s address PO BOX 407, LUVERNE, AL, 360490407

Signature of
Role Plan administrator
Date 2022-07-27
Name of individual signing SAMUEL WALKER
LUVERNE HEALTH CLINIC, P.A. PROFIT SHARING PLAN 2019 630798719 2020-06-16 LUVERNE HEALTH CLINIC P A 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1982-01-01
Business code 621111
Sponsor’s telephone number 3343356515
Plan sponsor’s address PO BOX 407, LUVERNE, AL, 360490407

Signature of
Role Plan administrator
Date 2020-06-16
Name of individual signing SAMUEL WALKER
LUVERNE HEALTH CLINIC, P.A. PROFIT SHARING PLAN 2018 630798719 2019-07-15 LUVERNE HEALTH CLINIC P A 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1982-01-01
Business code 621111
Sponsor’s telephone number 3343356515
Plan sponsor’s address PO BOX 407, LUVERNE, AL, 360490407

Signature of
Role Plan administrator
Date 2019-07-15
Name of individual signing SAMUEL WALKER
Role Employer/plan sponsor
Date 2019-07-15
Name of individual signing SAMUEL WALKER
LUVERNE HEALTH CLINIC, P.A. PROFIT SHARING PLAN 2017 630798719 2018-07-02 LUVERNE HEALTH CLINIC P A 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1982-01-01
Business code 621111
Sponsor’s telephone number 3343356515
Plan sponsor’s address PO BOX 407, LUVERNE, AL, 360490407

Signature of
Role Plan administrator
Date 2018-07-02
Name of individual signing SAMUEL WALKER
Role Employer/plan sponsor
Date 2018-07-02
Name of individual signing SAMUEL WALKER
LUVERNE HEALTH CLINIC, P.A. PROFIT SHARING PLAN 2016 630798719 2017-08-24 LUVERNE HEALTH CLINIC P A 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1982-01-01
Business code 621111
Sponsor’s telephone number 3343356515
Plan sponsor’s address PO BOX 407, LUVERNE, AL, 360490407

Signature of
Role Plan administrator
Date 2017-08-24
Name of individual signing SAMUEL WALKER
Role Employer/plan sponsor
Date 2017-08-24
Name of individual signing SAMUEL WALKER
LUVERNE HEALTH CLINIC P A PROFIT SHARING PLAN 2015 630798719 2016-07-28 LUVERNE HEALTH CLINIC P A 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1982-01-01
Business code 621111
Sponsor’s telephone number 3343356515
Plan sponsor’s address PO BOX 407, LUVERNE, AL, 360490407

Signature of
Role Plan administrator
Date 2016-07-28
Name of individual signing S.PATRICK WALKER
Role Employer/plan sponsor
Date 2016-07-28
Name of individual signing S.PATRICK WALKER
LUVERNE HEALTH CLINIC P A PROFIT SHARING PLAN 2014 630798719 2015-07-28 LUVERNE HEALTH CLINIC P A 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1982-01-01
Business code 621111
Sponsor’s telephone number 3343356515
Plan sponsor’s address PO BOX 407, LUVERNE, AL, 360490407

Signature of
Role Plan administrator
Date 2015-07-28
Name of individual signing SAMUEL WALKER
Role Employer/plan sponsor
Date 2015-07-28
Name of individual signing SAMUEL WALKER
LUVERNE HEALTH CLINIC P A PROFIT SHARING PLAN 2013 630798719 2014-10-30 LUVERNE HEALTH CLINIC P A 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1982-01-01
Business code 621111
Sponsor’s telephone number 3343356515
Plan sponsor’s address PO BOX 407, LUVERNE, AL, 360490407

Signature of
Role Plan administrator
Date 2014-10-30
Name of individual signing SAMUEL WALKER
Role Employer/plan sponsor
Date 2014-10-30
Name of individual signing SAMUEL WALKER
LUVERNE HEALTH CLINIC P A PROFIT SHARING PLAN 2012 630798719 2013-08-08 LUVERNE HEALTH CLINIC P A 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1982-01-01
Business code 621111
Sponsor’s telephone number 3343356515
Plan sponsor’s address PO BOX 407, LUVERNE, AL, 360490407

Signature of
Role Plan administrator
Date 2013-08-08
Name of individual signing SAMUEL WALKER
Role Employer/plan sponsor
Date 2013-08-08
Name of individual signing SAMUEL WALKER

Member

Name Role
WALKER, SAMUEL P Member

Related by officers

WALKER, SAMUEL P

J. S. Walker & Sons, Inc.

Related by address

No related companies by address

Date of last update: 31 Jul 2024

Sources: Alabama Secretary of State

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