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Vaughn H. Mancha, Jr., P.C.

Details

Name: Vaughn H. Mancha, Jr., P.C.
Jurisdiction: Alabama
Legal type: Domestic Professional Corporation
Status: Dissolved
Date of registration: 19 Oct 1993 (31 years ago)
Date of dissolution: 19 Dec 2016
Entity Number: 000-159-985
Register Number: 000159985
County: Montgomery
Place of Formation: Montgomery County
Principal Address: MONTGOMERY, AL
Registered Office Street Address: 1110 E FAIRVIEW AVEMONTGOMERY, AL 36106
Registered Office Street Address ZIP Code: 36106
Authorized Capital: $5,000
Paid Share Capital: ----

Activities PRACTICE OF MEDICINE

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1851685150 2011-06-03 2014-11-19 17328 BURWICK LOOP, FAIRHOPE, AL, 365325243, US 17328 BURWICK LOOP, FAIRHOPE, AL, 365325243, US

Contacts
Phone +1 334-300-2573
Phone +1 334-300-2511

Authorized person
Name MRS. DEBORAH B MANCHA
Role VICE-PRESIDENT
Phone 3343002573

Taxonomy
Taxonomy Code 207Q00000X - Family Medicine Physician
License Number 14167
State AL
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
VAUGHN H. MANCHA JR. P.C. 401K PLAN & TRUST 2015 631102851 2016-07-31 VAUGHN H. MANCHA JR. P.C. 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 3343002573
Plan sponsor’s address 17328 BURWICK LOOP, FAIRHOPE, AL, 365325243
VAUGHN H. MANCHA JR., P.C. 401K PLAN & TRUST 2014 631102851 2015-08-19 VAUGHN H. MANCHA JR., P.C. 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 3343002573
Plan sponsor’s address 17328 BURWICK LOOP, FAIRHOPE, AL, 36532
VAUGHN H. MANCHA JR., P.C. 401K PLAN & TRUST 2013 631102851 2014-07-29 VAUGHN H. MANCHA JR., P.C. 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 3343002573
Plan sponsor’s address 17328 BURWICK LOOP, FAIRHOPE, AL, 36532
VAUGHN H MANCHA JR., P.C. 401K PLAN & TRUST 2012 631102851 2013-04-25 VAUGHN H MANCHA JR., P.C. 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621210
Sponsor’s telephone number 3342646054
Plan sponsor’s address 339 ST LUKES DRIVE, MONTGOMERY, AL, 23236

Plan administrator’s name and address
Administrator’s EIN 631102851
Plan administrator’s name VAUGHN H MANCHA JR., P.C.
Plan administrator’s address 339 ST LUKES DRIVE, MONTGOMERY, AL, 23236
Administrator’s telephone number 3342646054

Signature of
Role Plan administrator
Date 2013-04-25
Name of individual signing VAUGHN H. MANCHA
VAUGHN H MANCHA JR., P.C. 401K PLAN & TRUST 2011 631102851 2012-07-01 VAUGHN H MANCHA JR., P.C. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621210
Sponsor’s telephone number 3342646054
Plan sponsor’s address 339 ST LUKES DRIVE, MONTGOMERY, AL, 23236

Plan administrator’s name and address
Administrator’s EIN 631102851
Plan administrator’s name VAUGHN H MANCHA JR., P.C.
Plan administrator’s address 339 ST LUKES DRIVE, MONTGOMERY, AL, 23236
Administrator’s telephone number 3342646054

Signature of
Role Plan administrator
Date 2012-07-01
Name of individual signing VAUGHN H. MANCHA
VAUGHN H MANCHA JR., P.C. 401K PLAN & TRUST 2010 631102851 2011-03-21 VAUGHN H MANCHA JR., P.C. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621210
Sponsor’s telephone number 3342646054
Plan sponsor’s address 339 ST LUKES DRIVE, MONTGOMERY, AL, 23236

Plan administrator’s name and address
Administrator’s EIN 631102851
Plan administrator’s name VAUGHN H MANCHA JR., P.C.
Plan administrator’s address 339 ST LUKES DRIVE, MONTGOMERY, AL, 23236
Administrator’s telephone number 3342646054

Signature of
Role Plan administrator
Date 2011-03-21
Name of individual signing VAUGHN H. MANCHA
VAUGHN H MANCHA JR., P.C. 401K PLAN & TRUST 2009 631102851 2010-09-22 VAUGHN H MANCHA JR., P.C. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621210
Sponsor’s telephone number 3342646054
Plan sponsor’s address 339 ST LUKES DRIVE, MONTGOMERY, AL, 23236

Plan administrator’s name and address
Administrator’s EIN 631102851
Plan administrator’s name VAUGHN H MANCHA JR., P.C.
Plan administrator’s address 339 ST LUKES DRIVE, MONTGOMERY, AL, 23236
Administrator’s telephone number 3342646054

Signature of
Role Plan administrator
Date 2010-09-22
Name of individual signing VAUGHN H. MANCHA

Agent

Name Role
MANCHA, VAUGHN H JR Agent

Incorporator

Name Role
SPEIR, W HOLT III Incorporator

Related by officers

MANCHA, VAUGHN H JR

Mancha Property Management, L.L.C. Mancha Property Management II, L.L.C. StatMed, LLC

SPEIR, W HOLT III

Hillwood Sunday Dining Club, Inc. P & CMA Educational Foundation, Inc. East Montgomery County Historical Society, Inc. Pegasus Title, Inc. Domestic Emergency and Abuse Program, Inc. Montgomery Friends of Public Radio, Inc. Manufacture Alabama, Inc. Southern Environmental Enforcement Training Fund The Alabama Foundation Birchfield Tool, Inc.

Related by address

MONTGOMERY, AL

A-1 Hurricane Fence Industries of Montgomery, Inc. AAA Builders, Inc. AAA Plumbing Pottery Corp. A. & B. Coffee Service, Inc. A-J Construction Co., Inc. A & M Furniture Mart, Inc. Academic and Athletic Excellence, Inc. A. Q. S. Incorporated A. T. A. Building, Inc. Ace Furniture Co., Inc.

Date of last update: 01 Aug 2024

Sources: Alabama Secretary of State

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