Rheumatology Associates of North Alabama, P.C.

Contacts

Phone	+1 256-767-6263
Fax	2567674583

Authorized person

Name	MS. CONNIE FRANCES DUFOUR
Role	PHYSICIAN CREDENTIALER
Phone	2567047040

Taxonomy

Taxonomy Code	207RR0500X - Rheumatology Physician
State	AL
Is Primary	Yes

Other Provider Identifiers

Issuer	MEDICAID
Number	529702140
State	AL

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1987-01-01
Business code	621111
Sponsor’s telephone number	2565516510
Plan sponsor’s address	720 GALLATIN STREET, SW, SUITE 500, HUNTSVILLE, AL, 35801

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1987-01-01
Business code	621111
Sponsor’s telephone number	2565516510
Plan sponsor’s address	720 GALLATIN STREET, SW, SUITE 500, HUNTSVILLE, AL, 35801

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1987-01-01
Business code	621111
Sponsor’s telephone number	2565516510
Plan sponsor’s mailing address	201 SIVLEY ROAD, SUITE 600, HUNTSVILLE, AL, 35801
Plan sponsor’s address	201 SIVLEY ROAD, SUITE 600, HUNTSVILLE, AL, 35801

Plan administrator’s name and address

Administrator’s EIN	630907980
Plan administrator’s name	JANE BROWN
Plan administrator’s address	201 SIVLEY ROAD, SUITE 600, HUNTSVILLE, AL, 35801
Administrator’s telephone number	2565516510

Number of participants as of the end of the plan year

Active participants	39
Retired or separated participants receiving benefits	0
Other retired or separated participants entitled to future benefits	0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits	0
Number of participants with account balances as of the end of the plan year	39
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	0

Signature of

Role	Plan administrator
Date	2010-10-14
Name of individual signing	JANE BROWN
Valid signature	Filed with authorized/valid electronic signature