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South Alabama Diagnostic Imaging, P.C.

Details

Name: South Alabama Diagnostic Imaging, P.C.
Jurisdiction: Alabama
Legal type: Domestic Professional Corporation
Status: Exists
Date of registration: 05 Jan 1995 (30 years ago) (Companies founded in January 1995)
Entity Number: 000-169-275
Register Number: 000169275
ZIP code: 36340 (Companies in Geneva, 36340)
County: Geneva
Place of Formation: Geneva County
Principal Address: GENEVA, AL
Registered Office Street Address: 1200 WEST MAPLE AVEGENEVA, AL 36340
Authorized Capital: $1,000
Paid Share Capital: $1,000

Activities PROVIDE INTERPRETATION OF ALL DIAGNOSTIC IMAGING PROCEDURES

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1477615938 2006-12-14 2019-06-14 PO BOX 1928, BAINBRIDGE, GA, 398181928, US 1200 W MAPLE AVE, GENEVA, AL, 363401642, US

Contacts
Phone +1 334-684-3655
Fax 3346843312
Phone +1 334-684-7156
Fax 3346847709

Authorized person
Name DR. JOHN C TOMBERLIN
Role OWNER
Phone 3346847156

Taxonomy
Taxonomy Code 2085R0202X - Diagnostic Radiology Physician
License Number 10925
State AL
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 000085322
State AL
Issuer FLORIDIA MEDICAID
Number 047944600
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
SOUTH ALABAMA DIAGNOSTIC IMAGING P.C. 401(K) RETIREMENT PLAN 2016 631133855 2017-07-03 SOUTH ALABAMA DIAGNOSTIC IMAGING P.C. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-08-15
Business code 621111
Sponsor’s telephone number 3346847156
Plan sponsor’s address 1200 W MAPLE AVE, GENEVA, AL, 363401642

Signature of
Role Plan administrator
Date 2017-07-03
Name of individual signing JOHNC TOMBERLIN
Role Employer/plan sponsor
Date 2017-07-03
Name of individual signing KATHY ALRED
SOUTH ALABAMA DIAGNOSTIC IMAGING P.C. 401(K) RETIREMENT PLAN 2015 631133855 2016-03-24 SOUTH ALABAMA DIAGNOSTIC IMAGING P.C. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-08-15
Business code 621111
Sponsor’s telephone number 3346847156
Plan sponsor’s address 1200 W MAPLE AVE, GENEVA, AL, 363401642

Signature of
Role Plan administrator
Date 2016-03-24
Name of individual signing KATHY ALRED
Role Employer/plan sponsor
Date 2016-03-24
Name of individual signing KATHY ALRED
SOUTH ALABAMA DIAGNOSTIC IMAGING P.C. 401(K) RETIREMENT PLAN 2014 631133855 2015-08-19 SOUTH ALABAMA DIAGNOSTIC IMAGING P.C. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-08-15
Business code 621111
Sponsor’s telephone number 3346847156
Plan sponsor’s address 1200 W MAPLE AVE, GENEVA, AL, 363401642

Signature of
Role Plan administrator
Date 2015-08-19
Name of individual signing KATHY ALRED
Role Employer/plan sponsor
Date 2015-08-19
Name of individual signing KATHY ALRED
SOUTH ALABAMA DIAGNOSTIC IMAGING P.C. 401(K) RETIREMENT PLAN 2013 631133855 2014-07-15 SOUTH ALABAMA DIAGNOSTIC IMAGING P.C. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-08-15
Business code 621111
Sponsor’s telephone number 3346847156
Plan sponsor’s address 1200 W MAPLE AVE, GENEVA, AL, 363401642

Signature of
Role Plan administrator
Date 2014-07-15
Name of individual signing ALRED KATHY
Role Employer/plan sponsor
Date 2014-07-15
Name of individual signing ALRED KATHY
SOUTH ALABAMA DIAGNOSTIC IMAGING P.C. 401(K) RETIREMENT PLAN 2012 631133855 2013-02-12 SOUTH ALABAMA DIAGNOSTIC IMAGING P.C. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-08-15
Business code 621111
Sponsor’s telephone number 3346847156
Plan sponsor’s address 1200 W MAPLE AVE, GENEVA, AL, 363401642

Signature of
Role Plan administrator
Date 2013-02-12
Name of individual signing KATHY ALRED
Role Employer/plan sponsor
Date 2013-02-12
Name of individual signing KATHY ALRED
SOUTH ALABAMA DIAGNOSTIC IMAGING P.C. 401(K) RETIREMENT PLAN 2011 631133855 2012-04-05 SOUTH ALABAMA DIAGNOSTIC IMAGING P.C. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-08-15
Business code 621111
Sponsor’s telephone number 3346847156
Plan sponsor’s address 1200 W MAPLE AVE, GENEVA, AL, 363401642

Plan administrator’s name and address
Administrator’s EIN 631133855
Plan administrator’s name SOUTH ALABAMA DIAGNOSTIC IMAGING P.C.
Plan administrator’s address 1200 W MAPLE AVE, GENEVA, AL, 363401642
Administrator’s telephone number 3346847156

Signature of
Role Plan administrator
Date 2012-04-05
Name of individual signing KATHY ALRED
Role Employer/plan sponsor
Date 2012-04-05
Name of individual signing KATHY ALRED
SOUTH ALABAMA DIAGNOSTIC IMAGING P.C. 401(K) RETIREMENT PLAN 2010 631133855 2011-02-11 SOUTH ALABAMA DIAGNOSTIC IMAGING P.C. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-08-15
Business code 621111
Sponsor’s telephone number 3346847156
Plan sponsor’s address 1200 W MAPLE AVE, GENEVA, AL, 363401642

Plan administrator’s name and address
Administrator’s EIN 631133855
Plan administrator’s name SOUTH ALABAMA DIAGNOSTIC IMAGING P.C.
Plan administrator’s address 1200 W MAPLE AVE, GENEVA, AL, 363401642
Administrator’s telephone number 3346847156

Signature of
Role Plan administrator
Date 2011-02-11
Name of individual signing KATHY ALRED
Role Employer/plan sponsor
Date 2011-02-11
Name of individual signing KATHY ALRED
SOUTH ALABAMA DIAGNOSTIC IMAGING P.C. 401(K) RETIREMENT PLAN 2009 631133855 2010-09-17 SOUTH ALABAMA DIAGNOSTIC IMAGING P.C. 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-08-15
Business code 621111
Sponsor’s telephone number 3346847156
Plan sponsor’s address 1200 W MAPLE AVE, GENEVA, AL, 363401642

Plan administrator’s name and address
Administrator’s EIN 631133855
Plan administrator’s name SOUTH ALABAMA DIAGNOSTIC IMAGING P.C.
Plan administrator’s address 1200 W MAPLE AVE, GENEVA, AL, 363401642
Administrator’s telephone number 3346847156

Signature of
Role Plan administrator
Date 2010-09-17
Name of individual signing JOHN TOMBERLIN
Role Employer/plan sponsor
Date 2010-09-17
Name of individual signing JOHN TOMBERLIN
SOUTH ALABAMA DIAGNOSTIC IMAGING P.C. 401(K) RETIREMENT PLAN 2009 631133855 2010-05-10 SOUTH ALABAMA DIAGNOSTIC IMAGING P.C. 10
Three-digit plan number (PN) 001
Effective date of plan 2004-08-15
Business code 621111
Sponsor’s telephone number 3346847156
Plan sponsor’s address 1200 W MAPLE AVE, GENEVA, AL, 363401642

Plan administrator’s name and address
Administrator’s EIN 631133855
Plan administrator’s name SOUTH ALABAMA DIAGNOSTIC IMAGING P.C.
Plan administrator’s address 1200 W MAPLE AVE, GENEVA, AL, 363401642
Administrator’s telephone number 3346847156

Signature of
Role Plan administrator
Date 2010-05-10
Name of individual signing JOHN C. TOMBERLIN, MD
Role Employer/plan sponsor
Date 2010-05-10
Name of individual signing JOHN C. TOMBERLIN, MD

Agent

Name Role
TOMBERLIN, JOHN C Agent

Incorporator

Name Role
TOMBERLIN, JOHN C Incorporator

Related by officers

TOMBERLIN, JOHN C

abCD, Inc. Enterprise Shell Supercenter, L.L.C. Har-Tom, L.L.C. Enterprise Therapy Center, L.L.C. Tomason Enterprises, Inc.

Related by address

GENEVA, AL

The American Bank Auto Sav of Geneva, Alabama Fleming Foods of Alabama, Inc. C and P Construction Company, Inc. The Citizens Bank Colonial Products Company, Incorporated,(Geneva, Alabama) Economy Gas Company, Geneva, Alabama Geneva Hardware Company, Inc. Geneva Loan Co. Baker Farm Supply, Inc.

Date of last update: 01 Aug 2024

Sources: Alabama Secretary of State

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