| Name: | East Alabama Cardiac and Thoracic Surgery, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Dissolved |
| Date of registration: | 02 Jul 1990 (34 years ago) |
| Date of dissolution: | 20 Nov 2015 |
| Entity Number: | 000-137-889 |
| Register Number: | 000137889 |
| County: | Lee |
| Place of Formation: | Lee County |
| Principal Address: | OPELIKA, AL |
| Registered Office Street Address: | 2000 PEPPERELL PKWYOPELIKA, AL 36801 |
| Registered Office Street Address ZIP Code: | 36801 |
| Authorized Capital: | $10 |
Activities
PRACTICE MEDICINE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1598827420 | 2006-12-15 | 2009-10-16 | 2000 PEPPERELL PKWY, PO BOX 2740, OPELIKA, AL, 368015452, US | 2000 PEPPERELL PKWY, OPELIKA, AL, 368015452, US | |||||||||||||||||||||||||||||||||||||||
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| Phone | +1 334-528-1720 |
| Fax | 3345281693 |
Authorized person
| Name | MRS. KELLY MARIE FARR |
| Role | OFFICE MANAGER |
| Phone | 3345281720 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| License Number | 19855 |
| State | AL |
| Is Primary | Yes |
| Taxonomy Code | 174400000X - Specialist |
| License Number | 22312 |
| State | AL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 009960240 |
| State | AL |
| Issuer | MEDICAID |
| Number | 110274 |
| State | AL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| EAST ALABAMA CARDIAC AND THORACIC SURGERY, P.C. 401(K) PLAN | 2014 | 631024529 | 2015-05-14 | EAST ALABAMA CARDIAC AND THORACIC SURGERY, P.C. | 3 | |||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2015-05-14 |
| Name of individual signing | LEE ROBERSON, M.D. |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2012-01-01 |
| Business code | 621493 |
| Sponsor’s telephone number | 3345281720 |
| Plan sponsor’s address | 2000 PEPPERELL PARKWAY, P.O. BOX 2740, OPELIKA, AL, 36801 |
Signature of
| Role | Plan administrator |
| Date | 2014-10-15 |
| Name of individual signing | LEE ROBERSON, M.D. |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2012-01-01 |
| Business code | 621493 |
| Sponsor’s telephone number | 3345281720 |
| Plan sponsor’s address | 2000 PEPPERELL PARKWAY, P.O. BOX 2740, OPELIKA, AL, 36801 |
Signature of
| Role | Plan administrator |
| Date | 2013-05-14 |
| Name of individual signing | KELLY FARR |
| Name | Role |
|---|---|
| ERATH, HAROLD G JR | Agent |
| Name | Role |
|---|---|
| ERATH, HAROLD G JR | Incorporator |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
