| Name: | Tennessee Valley ENT Clinic, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Dissolved |
| Date of registration: | 04 Nov 1991 (33 years ago) (Companies founded in November 1991) |
| Date of dissolution: | 18 Feb 2022 |
| Entity Number: | 000-146-056 |
| Register Number: | 000146056 |
| ZIP code: | 35660 (Companies in Colbert, 35660) |
| County: | Colbert |
| Place of Formation: | Colbert County |
| Principal Address: | SHEFFILED, AL |
| Registered Office Street Address: | 1100 JACKSON HWYSHEFFIELD, AL 35660 |
| Authorized Capital: | $10,000 |
Activities
MEDICINE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1710053087 | 2006-11-28 | 2020-08-22 | 323 N MONTGOMERY AVE, SHEFFIELD, AL, 356602708, US | 323 N MONTGOMERY AVE, SHEFFIELD, AL, 356602708, US | |||||||||||||||||||||||||
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| Phone | +1 256-381-6673 |
| Fax | 2563818091 |
Authorized person
| Name | DR. KENNETH F. LEMASTER |
| Role | PRESIDENT |
| Phone | 2563816673 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| License Number | 11543 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS OF ALABAMA PROVIDER |
| Number | 510-89320 |
| State | AL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| TENNESSEE VALLEY ENT CLINIC, P.C. PROFIT SHARING PLAN | 2009 | 631054738 | 2011-03-31 | TENNESSEE VALLEY ENT CLINIC, P.C. | 5 | |||||||||||||||||||||||||||||||||||||
|
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| Administrator’s EIN | 631054738 |
| Plan administrator’s name | TENNESSEE VALLEY ENT CLINIC, P.C. |
| Plan administrator’s address | 323 N MONTGOMERY AVE, SHEFFIELD, AL, 356602708 |
| Administrator’s telephone number | 2563816673 |
Signature of
| Role | Plan administrator |
| Date | 2011-03-31 |
| Name of individual signing | KENNETH LEMASTER |
| Role | Employer/plan sponsor |
| Date | 2011-03-31 |
| Name of individual signing | KENNETH LEMASTER |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 1993-10-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 2563816673 |
| Plan sponsor’s address | 323 N MONTGOMERY AVE, SHEFFIELD, AL, 356602708 |
Plan administrator’s name and address
| Administrator’s EIN | 631054738 |
| Plan administrator’s name | TENNESSEE VALLEY ENT CLINIC, P.C. |
| Plan administrator’s address | 323 N MONTGOMERY AVE, SHEFFIELD, AL, 356602708 |
| Administrator’s telephone number | 2563816673 |
Signature of
| Role | Plan administrator |
| Date | 2011-04-20 |
| Name of individual signing | KENNETH LEMASTER |
| Role | Employer/plan sponsor |
| Date | 2011-04-20 |
| Name of individual signing | KENNETH LEMASTER |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 1993-10-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 2563816673 |
| Plan sponsor’s address | 323 N MONTGOMERY AVE, SHEFFIELD, AL, 356602708 |
Plan administrator’s name and address
| Administrator’s EIN | 631054738 |
| Plan administrator’s name | TENNESSEE VALLEY ENT CLINIC, P.C. |
| Plan administrator’s address | 323 N MONTGOMERY AVE, SHEFFIELD, AL, 356602708 |
| Administrator’s telephone number | 2563816673 |
Signature of
| Role | Plan administrator |
| Date | 2011-04-20 |
| Name of individual signing | KENNETH LEMASTER |
| Role | Employer/plan sponsor |
| Date | 2011-04-20 |
| Name of individual signing | KENNETH LEMASTER |
| Name | Role |
|---|---|
| LEMASTER, KENNETH F MD | Agent |
| Name | Role |
|---|---|
| LEMASTER, KENNETH F MD | Incorporator |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
