| Name: | Alabama Gastroenterology Associates, P. C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Dissolved |
| Date of registration: | 05 Jan 1988 (37 years ago) (Companies founded in January 1988) |
| Date of dissolution: | 11 Aug 2010 |
| Entity Number: | 000-121-473 |
| Register Number: | 000121473 |
| ZIP code: | 35209 (Companies in Jefferson, 35209) |
| County: | Jefferson |
| Place of Formation: | Jefferson County |
| Registered Office Street Address: | 2022 BROOKWOOD MEDICAL CENTER DRIVE SUITE 514BIRMINGHAM, AL 35209 |
| Authorized Capital: | $1,000 |
Activities
PRACTICE OF MEDICINE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1558314591 | 2006-05-19 | 2020-08-22 | 2022 BROOKWOOD MEDICAL CTR DR, SUITE 626, BIRMINGHAM, AL, 352096808, US | 2022 BROOKWOOD MEDICAL CTR DR, SUITE 626, BIRMINGHAM, AL, 352096808, US | |||||||||||||||||||||||||||||
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| Phone | +1 205-871-3200 |
| Fax | 2058713272 |
Authorized person
| Name | DONNA DUNSON BEASLEY |
| Role | OFFICE MANAGER |
| Phone | 2058713200 |
Taxonomy
| Taxonomy Code | 207RG0100X - Gastroenterology Physician |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | RAILROAD MEDICARE PROVIDE |
| Number | CL0526 |
| State | AL |
| Issuer | UNITED HEALTHCARE PROVIDE |
| Number | 0023000 |
| State | AL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ALABAMA GASTROENTEROLOGY ASSOCIATES, P.C. 401(K) PROFIT SHARING PLAN | 2010 | 630966252 | 2010-06-23 | ALABAMA GASTROENTEROLOGY ASSOCIATES, P.C. | 1 | |||||||||||||||||||||||||||||||||||||
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| Administrator’s EIN | 630966252 |
| Plan administrator’s name | ALABAMA GASTROENTEROLOGY ASSOCIATES, P.C. |
| Plan administrator’s address | 2020 LAKE HEATHER DRIVE, BIRMINGHAM, AL, 35242 |
| Administrator’s telephone number | 2058713230 |
Signature of
| Role | Plan administrator |
| Date | 2010-06-23 |
| Name of individual signing | DOUGLAS DICKINSON |
| Role | Employer/plan sponsor |
| Date | 2010-06-23 |
| Name of individual signing | DOUGLAS DICKINSON |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 1988-01-05 |
| Business code | 621111 |
| Sponsor’s telephone number | 2058713230 |
| Plan sponsor’s address | 2020 LAKE HEATHER DRIVE, BIRMINGHAM, AL, 35242 |
Plan administrator’s name and address
| Administrator’s EIN | 630966252 |
| Plan administrator’s name | ALABAMA GASTROENTEROLOGY ASSOCIATES, P.C. |
| Plan administrator’s address | 2020 LAKE HEATHER DRIVE, BIRMINGHAM, AL, 35242 |
| Administrator’s telephone number | 2058713230 |
Signature of
| Role | Plan administrator |
| Date | 2010-05-24 |
| Name of individual signing | DOUGLAS S. DICKINSON, M.D. |
| Role | Employer/plan sponsor |
| Date | 2010-05-24 |
| Name of individual signing | DOUGLAS S. DICKINSON, M.D. |
| Name | Role | Address |
|---|---|---|
| DICKINSON, DOUGLAS S | Agent | 2020 LAKE HEATHER DRIVEBIRMINGHAM, AL 35242 |
| Name | Role | Address |
|---|---|---|
| DICKINSON, DOUGLAS S | Incorporator | 2020 LAKE HEATHER DRIVEBIRMINGHAM, AL 35242 |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
