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Affiliated Dermatology, P.C.

Details

Name: Affiliated Dermatology, P.C.
Jurisdiction: Alabama
Legal type: Domestic Professional Corporation
Status: Exists
Date of registration: 26 Jun 1990 (34 years ago)
Entity Number: 000-137-822
Register Number: 000137822
County: Houston
Place of Formation: Houston County
Registered Office Street Address: 3226 WEST MAIN STE 102 SOUTH TOWERDOTHAN, AL 36301
Registered Office Street Address ZIP Code: 36301
Authorized Capital: $1,200

Activities MEDICAL SERVICES OF/RELATED TO DERMATOLOGY

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1124008636 2006-01-19 2020-08-22 4300 W MAIN ST, SUITE 102, DOTHAN, AL, 363051054, US 4300 W MAIN ST, SUITE 102, DOTHAN, AL, 363051054, US

Contacts
Phone +1 334-793-9564
Fax 3346718907

Authorized person
Name MRS. LOIS W SALLAS
Role ADMINISTRATOR
Phone 3347939564

Taxonomy
Taxonomy Code 207N00000X - Dermatology Physician
Is Primary No
Taxonomy Code 207ND0101X - MOHS-Micrographic Surgery Physician
Is Primary No
Taxonomy Code 207NS0135X - Procedural Dermatology Physician
Is Primary No

Commercial and government entity program

CAGE number Status Type Established CAGE Update Date CAGE Expiration SAM Expiration
6LZD1 Obsolete Non-Manufacturer 2011-12-19 2022-11-02 2022-11-01 No data

Contact Information
POC SHEILA HERRING
Phone +1 334-793-9564
Fax +1 334-671-8907
Address 4300 W MAIN ST STE 102, DOTHAN, AL, 36305 1306, UNITED STATES

Ownership of Offeror Information
Highest Level Owner Information not Available
Immediate Level Owner Information not Available
List of Offerors (0) Information not Available

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
AFFILIATED DERMATOLOGY, P.C. PROFIT SHARING PLAN 2023 631025971 2024-07-26 AFFILIATED DERMATOLOGY, P.C. 20
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1991-01-01
Business code 621111
Sponsor’s telephone number 3347939564
Plan sponsor’s address 4300 WEST MAIN ST., STE 102, DOTHAN, AL, 36301
AFFILIATED DERMATOLOGY, P.C. PROFIT SHARING PLAN 2022 631025971 2023-07-26 AFFILIATED DERMATOLOGY, P.C. 30
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1991-01-01
Business code 621111
Sponsor’s telephone number 3347939564
Plan sponsor’s address 4300 WEST MAIN ST., STE 102, DOTHAN, AL, 36301
AFFILIATED DERMATOLOGY, P.C. PROFIT SHARING PLAN 2021 631025971 2022-07-29 AFFILIATED DERMATOLOGY, P.C. 30
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1991-01-01
Business code 621111
Sponsor’s telephone number 3347939564
Plan sponsor’s address 4300 WEST MAIN ST., STE 102, DOTHAN, AL, 36301
AFFILIATED DERMATOLOGY, P.C. PROFIT SHARING PLAN 2020 631025971 2021-08-02 AFFILIATED DERMATOLOGY, P.C. 30
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1991-01-01
Business code 621111
Sponsor’s telephone number 3347939564
Plan sponsor’s address 4300 WEST MAIN ST., STE 102, DOTHAN, AL, 36301
AFFILIATED DERMATOLOGY, P.C. PROFIT SHARING PLAN 2019 631025971 2020-07-23 AFFILIATED DERMATOLOGY, P.C. 31
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1991-01-01
Business code 621111
Sponsor’s telephone number 3347939564
Plan sponsor’s address 4300 WEST MAIN ST., STE 102, DOTHAN, AL, 36301
AFFILIATED DERMATOLOGY, P.C. PROFIT SHARING PLAN 2018 631025971 2019-07-25 AFFILIATED DERMATOLOGY, P.C. 30
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1991-01-01
Business code 621111
Sponsor’s telephone number 3347939564
Plan sponsor’s address 4300 WEST MAIN ST., STE 102, DOTHAN, AL, 36301
AFFILIATED DERMATOLOGY, P.C. PROFIT SHARING PLAN 2017 631025971 2018-06-29 AFFILIATED DERMATOLOGY, P.C. 26
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1991-01-01
Business code 621111
Sponsor’s telephone number 3347939564
Plan sponsor’s address 4300 WEST MAIN ST., STE 102, DOTHAN, AL, 36301
AFFILIATED DERMATOLOGY, P.C. PROFIT SHARING PLAN 2016 631025971 2017-07-27 AFFILIATED DERMATOLOGY, P.C. 26
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1991-01-01
Business code 621111
Sponsor’s telephone number 3347939564
Plan sponsor’s address 4300 WEST MAIN ST., STE 102, DOTHAN, AL, 36301
AFFILIATED DERMATOLOGY, P.C. PROFIT SHARING PLAN 2015 631025971 2016-07-28 AFFILIATED DERMATOLOGY, P.C. 27
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1991-01-01
Business code 621111
Sponsor’s telephone number 3347939564
Plan sponsor’s address 4300 WEST MAIN ST., STE 102, DOTHAN, AL, 36301
AFFILIATED DERMATOLOGY, P.C. PROFIT SHARING PLAN 2014 631025971 2015-07-28 AFFILIATED DERMATOLOGY, P.C. 22
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1991-01-01
Business code 621111
Sponsor’s telephone number 3347939564
Plan sponsor’s address 4300 WEST MAIN ST., STE 102, DOTHAN, AL, 36301

Agent

Name Role
ASH, ROBERT Agent

Incorporator

Name Role
ASH, ROBERT Incorporator

Related by officers

ASH, ROBERT

Teamsters Alabama Building Corporation

Related by address

No related companies by address

Date of last update: 01 Aug 2024

Sources: Alabama Secretary of State

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