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Gacek Ear and Sinus Center, LLC

Details

Name: Gacek Ear and Sinus Center, LLC
Jurisdiction: Alabama
Legal type: Domestic Limited Liability Company
Status: Exists
Date of registration: 31 Jan 2013 (12 years ago)
Entity Number: 000-068-334
Register Number: 000068334
Historical Names: Gacek Ear and Sinus Center LLC
Gacek Ear and Sinus Center, Inc.
County: Mobile
Place of Formation: Mobile County
Principal Address: 3715 DAUPHIN STREET STE 7AMOBILE, AL 36608
Principal Address ZIP Code: 36608
Registered Office Street Address: 363 CHARLESTON COURTMOBILE, AL 36608
Registered Office Street Address ZIP Code: 36608

Activities MEDICAL PRACTICE

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1932449451 2013-02-20 2022-08-24 4721 MORRISON DR STE 400, MOBILE, AL, 366093350, US 720 HILLCREST RD STE A, MOBILE, AL, 366953904, US

Contacts
Phone +1 251-340-6947
Fax 2514605457
Phone +1 251-340-7970
Fax 2513407971

Authorized person
Name DR. MARK R GACEK
Role OWNER/PRESIDENT
Phone 2513407970

Taxonomy
Taxonomy Code 207Y00000X - Otolaryngology Physician
License Number 0002170
State AL
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 147898
State AL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
GACEK EAR AND SINUS CENTER, LLC 401(K) PLAN 2023 462077310 2024-07-03 GACEK EAR AND SINUS CENTER, LLC 10
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2016-12-19
Business code 621111
Sponsor’s telephone number 2513407970
Plan sponsor’s address 720 HILLCREST ROAD, MOBILE, AL, 36695

Plan administrator’s name and address
Administrator’s EIN 474474775
Plan administrator’s name GUIDELINE, INC.
Plan administrator’s address 1412 CHAPIN AVENUE, BURLINGAME, CA, 94010
Administrator’s telephone number 8882283491

Signature of
Role Plan administrator
Date 2024-07-02
Name of individual signing QIAN LIU
GACEK EAR AND SINUS CENTER, LLC 401(K) PLAN 2022 462077310 2023-08-11 GACEK EAR AND SINUS CENTER, LLC 11
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2016-12-19
Business code 621111
Sponsor’s telephone number 2513407970
Plan sponsor’s address 100 MEMORIAL HOSPITAL DRIVE, SUITE 3C, MOBILE, AL, 36608

Plan administrator’s name and address
Administrator’s EIN 474474775
Plan administrator’s name GUIDELINE, INC.
Plan administrator’s address 1412 CHAPIN AVENUE, BURLINGAME, CA, 94010
Administrator’s telephone number 8882283491

Signature of
Role Plan administrator
Date 2023-08-11
Name of individual signing CHRISTINE RIMER
GACEK EAR AND SINUS CENTER, LLC 401(K) PLAN 2021 462077310 2022-07-16 GACEK EAR AND SINUS CENTER, LLC 11
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2016-12-19
Business code 621111
Sponsor’s telephone number 2513407970
Plan sponsor’s address 100 MEMORIAL HOSPITAL DRIVE, SUITE 3C, MOBILE, AL, 36608

Plan administrator’s name and address
Administrator’s EIN 474474775
Plan administrator’s name GUIDELINE, INC.
Plan administrator’s address 1645 E 6TH STREET, SUITE 200, AUSTIN, TX, 78702
Administrator’s telephone number 8882283491

Signature of
Role Plan administrator
Date 2022-07-15
Name of individual signing CHRISTINE RIMER
GACEK EAR AND SINUS CENTER, LLC 401(K) PLAN 2020 462077310 2021-04-30 GACEK EAR AND SINUS CENTER, LLC 11
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2016-12-19
Business code 621111
Sponsor’s telephone number 2513407970
Plan sponsor’s address 100 MEMORIAL HOSPITAL DRIVE, GLW ANNEX BLDG, SUITE 3C, MOBILE, AL, 36608

Plan administrator’s name and address
Administrator’s EIN 474474775
Plan administrator’s name GUIDELINE, INC.
Plan administrator’s address 3050 S DELAWARE ST, #202, SAN MATEO, CA, 94403
Administrator’s telephone number 8882283491

Signature of
Role Plan administrator
Date 2021-04-30
Name of individual signing CAROL HO
GACEK EAR & SINUS CENTER, LLC 401(K) PLAN 2019 462077310 2020-03-03 GACEK EAR AND SINUS CENTER, LLC 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-01-01
Business code 621111
Sponsor’s telephone number 2513407970
Plan sponsor’s address 100 MEMORIAL HOSPITAL DRIVE, GLW ANNEX BLDG, SUITE 3C, MOBILE, AL, 36608

Signature of
Role Plan administrator
Date 2020-03-03
Name of individual signing MICHAEL GACEK
GACEK EAR AND SINUS CENTER, LLC 401(K) PLAN 2019 462077310 2020-06-03 GACEK EAR AND SINUS CENTER, LLC 10
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2016-12-19
Business code 621111
Sponsor’s telephone number 2513407970
Plan sponsor’s address 100 MEMORIAL HOSPITAL DRIVE, GLW ANNEX BLDG, SUITE 3C, MOBILE, AL, 36608

Plan administrator’s name and address
Administrator’s EIN 474474775
Plan administrator’s name GUIDELINE, INC.
Plan administrator’s address 3050 S DELAWARE ST, #202, SAN MATEO, CA, 94403
Administrator’s telephone number 8882283491

Signature of
Role Plan administrator
Date 2020-06-03
Name of individual signing CAROL HO
GACEK EAR AND SINUS CENTER, LLC 401(K) PLAN 2019 462077310 2020-06-15 GACEK EAR AND SINUS CENTER, LLC 0
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-01-01
Business code 621111
Sponsor’s telephone number 2513407970
Plan sponsor’s address 100 MEMORIAL HOSPITAL DRIVE, GLW ANNEX BLDG, SUITE 3C, MOBILE, AL, 36608

Signature of
Role Plan administrator
Date 2020-06-15
Name of individual signing MICHAEL GACEK
GACEK EAR AND SINUS CENTER, LLC 401(K) PLAN 2018 462077310 2019-10-11 GACEK EAR AND SINUS CENTER, LLC 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-01-01
Business code 621111
Sponsor’s telephone number 2514047069
Plan sponsor’s address 100 MEMORIAL HOSPITAL DRIVE, GLW ANNEX BLDG, SUITE 3C, MOBILE, AL, 36608

Signature of
Role Plan administrator
Date 2019-10-11
Name of individual signing MICHAEL GACEK
GACEK EAR AND SINUS CENTER, LLC 401(K) PLAN 2018 462077310 2020-05-18 GACEK EAR AND SINUS CENTER, LLC 12
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2016-12-19
Business code 621111
Sponsor’s telephone number 2513407970
Plan sponsor’s address 100 MEMORIAL HOSPITAL DRIVE, GLW ANNEX BLDG, SUITE 3C, MOBILE, AL, 36608

Plan administrator’s name and address
Administrator’s EIN 474474775
Plan administrator’s name GUIDELINE, INC.
Plan administrator’s address 3050 S DELAWARE ST, #202, SAN MATEO, CA, 94403
Administrator’s telephone number 8882283491

Signature of
Role Plan administrator
Date 2020-05-18
Name of individual signing CAROL HO
GACEK EAR AND SINUS CENTER, LLC 401(K) PLAN 2018 462077310 2020-03-03 GACEK EAR AND SINUS CENTER, LLC 0
Three-digit plan number (PN) 001
Effective date of plan 2014-01-01
Business code 621111
Sponsor’s telephone number 2513407970
Plan sponsor’s address 100 MEMORIAL HOSPITAL DRIVE, GLW ANNEX BLDG, SUITE 3C, MOBILE, AL, 36608

Signature of
Role Plan administrator
Date 2020-03-03
Name of individual signing MICHAEL GACEK

Agent

Name Role Address
GACEK, MARK R Agent 363 CHARLESTON COURTMOBILE, AL 36608

Organizer

Name Role Address
GACEK, MARK RICHARD Organizer 3715 DAUPHIN STREET, SUITE 7AMOBILE, AL 36608-1771
GACEK, MARK R Organizer 363 CHARLESTON COURTMOBILE, AL 36608

Events

Event Date Event Type Old Value New Value
2013-09-24 Name Change Gacek Ear and Sinus Center, Inc. Gacek Ear and Sinus Center, LLC
2013-05-16 Name Change Gacek Ear and Sinus Center LLC Gacek Ear and Sinus Center, Inc.

Related by officers

GACEK, MARK R

DMJV, LLC

Related by address

363 CHARLESTON COURTMOBILE, AL 36608

Gear Up, Inc.

Date of last update: 31 Jul 2024

Sources: Alabama Secretary of State

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