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Birmingham Ear, Nose & Throat Group, P.C.

Details

Name: Birmingham Ear, Nose & Throat Group, P.C.
Jurisdiction: Alabama
Legal type: Domestic Professional Corporation
Status: Dissolved
Date of registration: 01 May 1986 (39 years ago)
Date of dissolution: 30 Dec 2019
Entity Number: 000-110-469
Register Number: 000110469
Historical Names: Robert L. Baldwin, M.D., P.C.
The Baldwin ENT Group, P.C.
County: Jefferson
Place of Formation: Jefferson County
Principal Address: BIRMINGHAM, AL
Registered Office Street Address: 2700 10TH AVE SOUTH STE 502BIRMINGHAM, AL 35205
Registered Office Street Address ZIP Code: 35205
Authorized Capital: $5,000

Activities MEDICINE

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1184789588 2006-12-26 2010-02-09 2700 10TH AVE S STE 502, BIRMINGHAM, AL, 352051250, US 2700 10TH AVE S STE 502, BIRMINGHAM, AL, 352051250, US

Contacts
Phone +1 205-933-2952
Fax 2059335893

Authorized person
Name MRS. MARCIA L LOWRY
Role OFFICE MANAGER
Phone 2059332952

Taxonomy
Taxonomy Code 207Y00000X - Otolaryngology Physician
License Number 00010997
State AL
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 000032702
State AL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
BIRMINGHAM EAR, NOSE & THROAT GROUP, P.C. 401K PROFIT SHARING PLAN 2015 630927686 2016-11-30 BIRMINGHAM EAR, NOSE & THROAT GROUP , P.C. 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1986-05-01
Business code 621111
Sponsor’s telephone number 2059332952
Plan sponsor’s address 2700 10TH AVENUE SOUTH, SUITE 502, BIRMINGHAM, AL, 352051250

Signature of
Role Plan administrator
Date 2016-11-30
Name of individual signing LEV H. BRAGG, M.D.
BIRMINGHAM EAR, NOSE & THROAT GROUP, P.C. 401K PROFIT SHARING PLAN 2014 630927686 2015-09-30 BIRMINGHAM EAR, NOSE & THROAT GROUP , P.C. 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1986-05-01
Business code 621111
Sponsor’s telephone number 2059332952
Plan sponsor’s address 2700 10TH AVENUE SOUTH, SUITE 502, BIRMINGHAM, AL, 352051250

Signature of
Role Plan administrator
Date 2015-09-30
Name of individual signing LEV H. BRAGG, M.D.
BIRMINGHAM EAR, NOSE & THROAT GROUP, P.C. 401K PROFIT SHARING PLAN 2013 630927686 2015-02-11 BIRMINGHAM EAR, NOSE & THROAT GROUP , P.C. 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1986-05-01
Business code 621111
Sponsor’s telephone number 2059332952
Plan sponsor’s address 2700 10TH AVENUE SOUTH, SUITE 502, BIRMINGHAM, AL, 352051250

Signature of
Role Plan administrator
Date 2015-02-11
Name of individual signing LEV H. BRAGG, M.D.
BIRMINGHAM EAR, NOSE & THROAT GROUP, P.C. 401K PROFIT SHARING PLAN 2012 630927686 2014-01-28 BIRMINGHAM EAR, NOSE & THROAT GROUP , P.C. 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1986-05-01
Business code 621111
Sponsor’s telephone number 2059332952
Plan sponsor’s address 2700 10TH AVENUE SOUTH, SUITE 502, BIRMINGHAM, AL, 352051250

Signature of
Role Plan administrator
Date 2014-01-28
Name of individual signing LEV H. BRAGG, M.D.
Role Employer/plan sponsor
Date 2014-01-28
Name of individual signing LEV H. BRAGG, M.D.
BIRMINGHAM EAR, NOSE & THROAT GROUP, P.C. 401K PROFIT SHARING PLAN 2011 630927686 2012-10-05 BIRMINGHAM EAR, NOSE & THROAT GROUP , P.C. 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1986-05-01
Business code 621111
Sponsor’s telephone number 2059332952
Plan sponsor’s address 2700 10TH AVENUE SOUTH, SUITE 502, BIRMINGHAM, AL, 352051250

Plan administrator’s name and address
Administrator’s EIN 630927686
Plan administrator’s name BIRMINGHAM EAR, NOSE & THROAT GROUP , P.C.
Plan administrator’s address 2700 10TH AVENUE SOUTH, SUITE 502, BIRMINGHAM, AL, 352051250
Administrator’s telephone number 2059332952

Signature of
Role Plan administrator
Date 2012-10-05
Name of individual signing LEV H. BRAGG, M.D.
Role Employer/plan sponsor
Date 2012-10-05
Name of individual signing LEV H. BRAGG, M.D.
BIRMINGHAM EAR, NOSE & THROAT GROUP, P.C. 401K PROFIT SHARING PLAN 2010 630927686 2011-11-29 BIRMINGHAM EAR, NOSE & THROAT GROUP , P.C. 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1986-05-01
Business code 621111
Sponsor’s telephone number 2059332952
Plan sponsor’s address 2700 10TH AVENUE SOUTH, SUITE 502, BIRMINGHAM, AL, 352051250

Plan administrator’s name and address
Administrator’s EIN 630927686
Plan administrator’s name BIRMINGHAM EAR, NOSE & THROAT GROUP , P.C.
Plan administrator’s address 2700 10TH AVENUE SOUTH, SUITE 502, BIRMINGHAM, AL, 352051250
Administrator’s telephone number 2059332952

Signature of
Role Plan administrator
Date 2011-11-28
Name of individual signing LEV H. BRAGG, M.D.
Role Employer/plan sponsor
Date 2011-11-28
Name of individual signing LEV H. BRAGG, M.D.
BIRMINGHAM EAR, NOSE & THROAT GROUP, P.C. 401K PROFIT SHARING PLAN 2009 630927686 2010-11-24 BIRMINGHAM EAR, NOSE & THROAT GROUP , P.C. 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1986-05-01
Business code 621111
Sponsor’s telephone number 2059332952
Plan sponsor’s address 2700 10TH AVENUE SOUTH, SUITE 502, BIRMINGHAM, AL, 35205

Plan administrator’s name and address
Administrator’s EIN 630927686
Plan administrator’s name BIRMINGHAM EAR, NOSE & THROAT GROUP , P.C.
Plan administrator’s address 2700 10TH AVENUE SOUTH, SUITE 502, BIRMINGHAM, AL, 35205
Administrator’s telephone number 2059332952

Signature of
Role Plan administrator
Date 2010-11-24
Name of individual signing LEV H. BRAGG, M.D.
Role Employer/plan sponsor
Date 2010-11-24
Name of individual signing LEV H. BRAGG, M.D.

Agent

Name Role
LEJEUNE, H B Agent

Incorporator

Name Role
BALDWIN, ROBERT L MD Incorporator

Events

Event Date Event Type Old Value New Value
1993-01-26 Name Change The Baldwin ENT Group, P.C. Birmingham Ear, Nose & Throat Group, P.C.
1987-06-12 Name Change Robert L. Baldwin, M.D., P.C. The Baldwin ENT Group, P.C.

Related by officers

No related officers

Related by address

BIRMINGHAM, AL

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2700 10TH AVE SOUTH STE 502BIRMINGHAM, AL 35205

Birmingham Hearing and Balance Center, P.C. ENT Imaging, LLC

Date of last update: 31 Jul 2024

Sources: Alabama Secretary of State

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