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Ear, Nose, Throat, Head & Neck Surgery of Huntsville, P.C.

Details

Name: Ear, Nose, Throat, Head & Neck Surgery of Huntsville, P.C.
Jurisdiction: Alabama
Legal type: Domestic Professional Corporation
Status: Exists
Date of registration: 13 Jul 1994 (30 years ago)
Entity Number: 000-165-441
Register Number: 000165441
Historical Names: Steven R. Smith, M.D., P.C.
County: Madison
Place of Formation: Madison County
Principal Address: HUNTSVILLE, AL
Registered Office Street Address: 201 WHITESPORT DRHUNTSVILLE, AL 35801
Registered Office Street Address ZIP Code: 35801
Authorized Capital: $1,000
Paid Share Capital: ----

Activities PRACTICE OF MEDICINE

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1952478752 2006-11-29 2021-05-13 201 WHITESPORT DR SW, HUNTSVILLE, AL, 358016449, US 201 WHITESPORT DR SW, HUNTSVILLE, AL, 358016449, US

Contacts
Phone +1 256-881-5353
Fax 2568810712

Authorized person
Name MS. STACI KRAUSE
Role OFFICE MANAGER
Phone 2568815353

Taxonomy
Taxonomy Code 174400000X - Specialist
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 529910620
State AL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
EAR, NOSE, THROAT, HEAD & NECK SURGERY OF HUNTSVILLE, P.C. 401K PROFIT SHARING PLAN 2013 631122866 2014-11-24 EAR, NOSE, THROAT, HEAD & NECK SURGERY OF HUNTSVILLE, P.C. 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1996-01-01
Business code 621111
Sponsor’s telephone number 2568815353
Plan sponsor’s address 201 WHITESPORT DRIVE, HUNTSVILLE, AL, 35801

Plan administrator’s name and address
Administrator’s EIN 631122866
Plan administrator’s name EAR, NOSE, THROAT, HEAD & NECK SURGERY OF HUNTSVILLE, P.C.
Plan administrator’s address 201 WHITESPORT DRIVE, HUNTSVILLE, AL, 35801
Administrator’s telephone number 2568815353
EAR, NOSE, THROAT, HEAD & NECK SURGERY OF HUNTSVILLE, P.C. 401K PROFIT SHARING PLAN 2012 631122866 2014-07-02 EAR, NOSE, THROAT, HEAD & NECK SURGERY OF HUNTSVILLE, P.C. 30
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1996-01-01
Business code 621111
Sponsor’s telephone number 2568815353
Plan sponsor’s address 201 WHITESPORT DRIVE, HUNTSVILLE, AL, 35801

Plan administrator’s name and address
Administrator’s EIN 631122866
Plan administrator’s name EAR, NOSE, THROAT, HEAD & NECK SURGERY OF HUNTSVILLE, P.C.
Plan administrator’s address 201 WHITESPORT DRIVE, HUNTSVILLE, AL, 35801
Administrator’s telephone number 2568815353

Signature of
Role Plan administrator
Date 2014-07-02
Name of individual signing J. FASSE, TPA
EAR, NOSE, THROAT, HEAD & NECK SURGERY OF HUNTSVILLE, P.C. 401K PROFIT SHARING PLAN 2011 631122866 2013-03-19 EAR, NOSE, THROAT, HEAD & NECK SURGERY OF HUNTSVILLE, P.C. 28
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1996-01-01
Business code 621111
Sponsor’s telephone number 2568815353
Plan sponsor’s address 201 WHITESPORT DRIVE, HUNTSVILLE, AL, 35801

Plan administrator’s name and address
Administrator’s EIN 631122866
Plan administrator’s name EAR, NOSE, THROAT, HEAD & NECK SURGERY OF HUNTSVILLE, P.C.
Plan administrator’s address 201 WHITESPORT DRIVE, HUNTSVILLE, AL, 35801
Administrator’s telephone number 2568815353

Signature of
Role Plan administrator
Date 2013-03-19
Name of individual signing J FASSE, TPA

Agent

Name Role
HAGOOD, MARK Agent

Incorporator

Name Role
SMITH, STEVEN R MD Incorporator

Events

Event Date Event Type Old Value New Value
1995-01-25 Name Change Steven R. Smith, M.D., P.C. Ear, Nose, Throat, Head & Neck Surgery of Huntsville, P.C.

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HAGOOD, MARK

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HUNTSVILLE, AL

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201 WHITESPORT DRHUNTSVILLE, AL 35801

D & H Properties, L.L.C.

Date of last update: 01 Aug 2024

Sources: Alabama Secretary of State

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