| Name: | Shoals Pediatric Group, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 01 Oct 1991 (33 years ago) |
| Entity Number: | 000-145-493 |
| Register Number: | 000145493 |
| County: | Lauderdale |
| Place of Formation: | Lauderdale County |
| Principal Address: | FLORENCE, AL |
| Registered Office Street Address: | 204 ANA DRIVEFLORENCE, AL 35630 |
| Registered Office Street Address ZIP Code: | 35630 |
| Authorized Capital: | $10 |
Activities
PHYSICIANS
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1609971647 | 2006-09-14 | 2020-08-22 | 208 ANA DR, FLORENCE, AL, 356301750, US | 208 ANA DR, FLORENCE, AL, 356301750, US | |||||||||||||||
|
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| Phone | +1 256-766-3983 |
| Fax | 2567641554 |
Authorized person
| Name | MRS. GLENDA HOWARD MARKS |
| Role | OFFICE MANAGER |
| Phone | 2567663983 |
Taxonomy
| Taxonomy Code | 208000000X - Pediatrics Physician |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SHOALS PEDIATRIC GROUP, P.C. 401(K) PLAN | 2023 | 631053941 | 2024-07-15 | SHOALS PEDIATRIC GROUP, P.C. | 17 | |||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2024-07-15 |
| Name of individual signing | SARAH KELLEY |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2022-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 2567663983 |
| Plan sponsor’s address | 208 ANA DRIVE, FLORENCE, AL, 35630 |
Signature of
| Role | Plan administrator |
| Date | 2023-09-07 |
| Name of individual signing | SARAH KELLEY |
| Name | Role |
|---|---|
| HAMMOND, DANIEL J DR | Agent |
| Name | Role |
|---|---|
| HAMMOND, DANIEL J DR | Incorporator |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
