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Dost M. Khattak, M.D., P.C.

Details

Name: Dost M. Khattak, M.D., P.C.
Jurisdiction: Alabama
Legal type: Domestic Professional Corporation
Status: Dissolved
Date of registration: 20 Oct 1981 (43 years ago)
Date of dissolution: 31 May 2012
Entity Number: 000-084-572
Register Number: 000084572
County: Madison
Place of Formation: Madison County
Principal Address: HUNTSVILLE, AL
Registered Office Street Address: 930 FRANKLIN ST SUITE 209HUNTSVILLE, AL 35801
Registered Office Street Address ZIP Code: 35801
Authorized Capital: $1,000

Activities PRACTICE MEDICINE

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1154537553 2007-05-15 2020-08-22 333 WHITESPORT DR SW, SUITE 304, HUNTSVILLE, AL, 358016454, US 333 WHITESPORT DR SW, SUITE 304, HUNTSVILLE, AL, 358016454, US

Contacts

Phone +1 256-880-0800
Fax 2568823556

Authorized person

Name MS. THERESA A JOHNSON
Role INSURANCE CLERK
Phone 2568800800

Taxonomy

Taxonomy Code 173000000X - Legal Medicine
License Number 9080
State AL
Is Primary Yes

Other Provider Identifiers

Issuer SOLO NPI NUMBER
Number 1427005560
State AL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
DOST M. KHATTAK, M.D., P.C. RETIREMENT PLAN AND TRUST 2009 630815674 2010-10-11 DOST M. KHATTAK, M.D., P.C. 5
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 2568800800
Plan sponsor’s address 333 WHITESPORT DR., STE. 304, HUNTSVILLE, AL, 358013455

Plan administrator’s name and address

Administrator’s EIN 630815674
Plan administrator’s name DOST M. KHATTAK, M.D., P.C.
Plan administrator’s address 333 WHITESPORT DR., STE. 304, HUNTSVILLE, AL, 358013455
Administrator’s telephone number 2568800800

Signature of

Role Plan administrator
Date 2010-10-11
Name of individual signing DOST M. KHATTAK, PRESIDENT

Agent

Name Role
KHATTAK, DOST M MD Agent

Incorporator

Name Role
KHATTAK, DOST M MD Incorporator

Date of last update: 31 Jul 2024

Sources: Alabama Secretary of State