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The Elberta Clinic, P.C.

Details

Name: The Elberta Clinic, P.C.
Jurisdiction: Alabama
Legal type: Domestic Professional Corporation
Status: Exists
Date of registration: 05 Oct 1994 (30 years ago) (Companies founded in October 1994)
Entity Number: 000-167-366
Register Number: 000167366
Place of Formation: Baldwin County
Principal Address: ELBERTA, AL
Registered Office Street Address: 24980 STATE STELBERTA, AL
Authorized Capital: $1,000
Paid Share Capital: $1,000

Activities PRACTICE OF MEDICINE

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1588752844 2006-10-11 2020-02-20 24980 STATE ST, PO DRAWER 519, ELBERTA, AL, 365302573, US 24980 STATE ST, PO DRAWER 519, ELBERTA, AL, 365302573, US

Contacts
Phone +1 251-986-7301
Fax 2519865927

Authorized person
Name DR. TERRY A. KURTTS
Role OWNER
Phone 2519867301

Taxonomy
Taxonomy Code 207Q00000X - Family Medicine Physician
Is Primary Yes
Taxonomy Code 207R00000X - Internal Medicine Physician
Is Primary No

Other Provider Identifiers
Issuer MEDICAID
Number 529500390
State AL
Issuer BLUE CROSS BLUE SHIELD AL
Number BCBS
State AL
Issuer RAILROAD MEDICARE
Number CN3899
State AL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
ELBERTA CLINIC, P.C. 401(K) PROFIT SHARING PLAN 2023 631125316 2024-08-14 THE ELBERTA CLINIC, P.C. 23
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1996-01-01
Business code 621399
Sponsor’s telephone number 2519867301
Plan sponsor’s address P.O. DRAWER 519, ELBERTA, AL, 36530

Signature of
Role Plan administrator
Date 2024-08-14
Name of individual signing TERRY KURTTS
ELBERTA CLINIC, P.C. 401(K) PROFIT SHARING PLAN 2022 631125316 2023-06-29 THE ELBERTA CLINIC, P.C. 20
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1996-01-01
Business code 621399
Sponsor’s telephone number 2519867301
Plan sponsor’s address P.O. DRAWER 519, ELBERTA, AL, 36530

Signature of
Role Plan administrator
Date 2023-06-29
Name of individual signing TERRY KURTTS
ELBERTA CLINIC, P.C. 401(K) PROFIT SHARING PLAN 2021 631125316 2022-09-20 THE ELBERTA CLINIC, P.C. 20
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1996-01-01
Business code 621399
Sponsor’s telephone number 2519867301
Plan sponsor’s address P.O. DRAWER 519, ELBERTA, AL, 36530

Signature of
Role Plan administrator
Date 2022-09-20
Name of individual signing TERRY KURTTS
ELBERTA CLINIC, P.C. 401(K) PROFIT SHARING PLAN 2020 631125316 2021-07-09 THE ELBERTA CLINIC, P.C. 18
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1996-01-01
Business code 621399
Sponsor’s telephone number 2519867301
Plan sponsor’s address P.O. DRAWER 519, ELBERTA, AL, 36530

Signature of
Role Plan administrator
Date 2021-07-09
Name of individual signing TERRY KURTTS
ELBERTA CLINIC, P.C. 401(K) PROFIT SHARING PLAN 2019 631125316 2020-07-13 THE ELBERTA CLINIC, P.C. 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1996-01-01
Business code 621399
Sponsor’s telephone number 2519867301
Plan sponsor’s address P.O. DRAWER 519, ELBERTA, AL, 36530

Signature of
Role Plan administrator
Date 2020-07-13
Name of individual signing TERRY KURTTS
ELBERTA CLINIC, P.C. 401(K) PROFIT SHARING PLAN 2018 631125316 2019-07-10 THE ELBERTA CLINIC, P.C. 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1996-01-01
Business code 621399
Sponsor’s telephone number 2519867301
Plan sponsor’s address P.O. DRAWER 519, ELBERTA, AL, 36530

Signature of
Role Plan administrator
Date 2019-07-10
Name of individual signing TERRY KURTTS
ELBERTA CLINIC, P.C. 401(K) PROFIT SHARING PLAN 2017 631125316 2018-05-14 THE ELBERTA CLINIC, P.C. 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1996-01-01
Business code 621399
Sponsor’s telephone number 2519867301
Plan sponsor’s address P.O. DRAWER 519, ELBERTA, AL, 36530

Signature of
Role Plan administrator
Date 2018-05-14
Name of individual signing TERRY KURTTS
ELBERTA CLINIC, P.C. 401(K) PROFIT SHARING PLAN 2016 631125316 2017-05-24 THE ELBERTA CLINIC, P.C. 19
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1996-01-01
Business code 621399
Sponsor’s telephone number 2519867301
Plan sponsor’s address P.O. DRAWER 519, ELBERTA, AL, 36530

Signature of
Role Plan administrator
Date 2017-05-24
Name of individual signing TERRY KURTTS
ELBERTA CLINIC, P.C. 401(K) PROFIT SHARING PLAN 2015 631125316 2016-03-15 THE ELBERTA CLINIC, P.C. 17
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1996-01-01
Business code 621399
Sponsor’s telephone number 2519867301
Plan sponsor’s address P.O. DRAWER 519, ELBERTA, AL, 36530

Signature of
Role Plan administrator
Date 2016-03-15
Name of individual signing TERRY KURTTS
ELBERTA CLINIC, P.C. 401(K) PROFIT SHARING PLAN 2014 631125316 2015-06-10 THE ELBERTA CLINIC, P.C. 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1996-01-01
Business code 621399
Sponsor’s telephone number 2519867301
Plan sponsor’s address P.O. DRAWER 519, ELBERTA, AL, 36530

Signature of
Role Plan administrator
Date 2015-06-10
Name of individual signing TERRY KURTTS

Agent

Name Role Address
KURTTS, TERRY Agent 25780 WOERNER ROADELBERTA, AL 36530

Incorporator

Name Role Address
KURTTS, TERRY Incorporator 25780 WOERNER ROADELBERTA, AL 36530

Related by officers

KURTTS, TERRY

HUT OF ELBERTA, LLC

Related by address

ELBERTA, AL

Baldwin Perdido Company Elberta Farmers Co-op Red Star Cabbage, Inc. E S Baldwin Enterprises, Inc. Woerner Magnolia Farms, Inc. Casa Builders, Inc. Osprey, Inc. Harrison & Harrison Electrical & Construction, Inc. Gulf Coast Turf Farm, Inc. Kichler's Flu Dust, Inc.

Date of last update: 01 Aug 2024

Sources: Alabama Secretary of State

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