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Azalea City Plastic Surgery, P.C.

Details

Name: Azalea City Plastic Surgery, P.C.
Jurisdiction: Alabama
Legal type: Domestic Professional Corporation
Status: Dissolved
Date of registration: 17 Jan 1996 (29 years ago)
Date of dissolution: 20 Sep 2021
Entity Number: 000-176-763
Register Number: 000176763
County: Mobile
Place of Formation: Mobile County
Principal Address: MOBILE, AL
Registered Office Street Address: 6701 AIRPORT BLVD STE B223MOBILE, AL 36608
Registered Office Street Address ZIP Code: 36608
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
1447425533 2008-04-29 2008-04-29 101 MEMORIAL HOSPITAL DR, BLDG #3 SUITE #309, MOBILE, AL, 366081786, US 101 MEMORIAL HOSPITAL DR, BLDG #3 SUITE #309, MOBILE, AL, 366081786, US

Contacts
Phone +1 251-344-1151
Fax 2513442113

Authorized person
Name DR. STEPHEN R SHEPPARD
Role OWNER
Phone 2513441151

Taxonomy
Taxonomy Code 174400000X - Specialist
License Number AL10348
State AL
Is Primary Yes

Other Provider Identifiers
Issuer DR STEPHEN R SHEPPARD NPI
Number 1194832360
State AL
Issuer BCBSAL PROVIER #
Number 17398
State AL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
AZALEA CITY PLASTIC SURGERY, P.C. DEFINED BENEFIT PLAN 2014 621160391 2015-07-28 AZALEA CITY PLASTIC SURGERY, P.C. 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-01-01
Business code 621111
Sponsor’s telephone number 2513441151
Plan sponsor’s address 101 MEMORIAL HOSPITAL DR., STE 309, MOBILE, AL, 36608

Signature of
Role Plan administrator
Date 2015-07-28
Name of individual signing STEPHEN R. SHEPPARD
AZALEA CITY PLASTIC SURGERY, P.C. DEFINED BENEFIT PLAN 2013 621160391 2014-10-02 AZALEA CITY PLASTIC SURGERY, P.C. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-01-01
Business code 621111
Sponsor’s telephone number 2513441151
Plan sponsor’s address 101 MEMORIAL HOSPITAL DR., STE 309, MOBILE, AL, 36608

Signature of
Role Plan administrator
Date 2014-10-02
Name of individual signing STEPHEN R. SHEPPARD
AZALEA CITY PLASTIC SURGERY, P.C. DEFINED BENEFIT PLAN 2012 621160391 2013-07-23 AZALEA CITY PLASTIC SURGERY, P.C. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-01-01
Business code 621111
Sponsor’s telephone number 2513441151
Plan sponsor’s address 101 MEMORIAL HOSPITAL DR., STE 309, MOBILE, AL, 36608

Signature of
Role Plan administrator
Date 2013-07-23
Name of individual signing STEPHEN R. SHEPPARD
AZALEA CITY PLASTIC SURGERY, P.C. DEFINED BENEFIT PLAN 2011 621160391 2012-10-08 AZALEA CITY PLASTIC SURGERY, P.C. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-01-01
Business code 621111
Sponsor’s telephone number 2513441151
Plan sponsor’s address 101 MEMORIAL HOSPITAL DR., STE 309, MOBILE, AL, 36608

Plan administrator’s name and address
Administrator’s EIN 621160391
Plan administrator’s name AZALEA CITY PLASTIC SURGERY, P.C.
Plan administrator’s address 101 MEMORIAL HOSPITAL DR., STE 309, MOBILE, AL, 36608
Administrator’s telephone number 2513441151

Signature of
Role Plan administrator
Date 2012-10-08
Name of individual signing STEPHEN R. SHEPPARD
Role Employer/plan sponsor
Date 2012-10-08
Name of individual signing STEPHEN R. SHEPPARD
AZALEA CITY PLASTIC SURGERY, P.C. DEFINED BENEFIT PLAN 2010 621160391 2011-09-26 AZALEA CITY PLASTIC SURGERY, P.C. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-01-01
Business code 621111
Sponsor’s telephone number 2513441151
Plan sponsor’s address 101 MEMORIAL HOSPITAL DR., STE 309, MOBILE, AL, 36608

Plan administrator’s name and address
Administrator’s EIN 621160391
Plan administrator’s name AZALEA CITY PLASTIC SURGERY, P.C.
Plan administrator’s address 101 MEMORIAL HOSPITAL DR., STE 309, MOBILE, AL, 36608
Administrator’s telephone number 2513441151

Signature of
Role Plan administrator
Date 2011-09-26
Name of individual signing STEPHEN R. SHEPPARD
AZALEA CITY PLASTIC SURGERY, P.C. DEFINED BENEFIT PLAN 2009 621160391 2010-10-05 AZALEA CITY PLASTIC SURGERY, P.C. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-01-01
Business code 621111
Sponsor’s telephone number 2513441151
Plan sponsor’s address 101 MEMORIAL HOSPITAL DR., STE 309, MOBILE, AL, 36608

Plan administrator’s name and address
Administrator’s EIN 621160391
Plan administrator’s name AZALEA CITY PLASTIC SURGERY, P.C.
Plan administrator’s address 101 MEMORIAL HOSPITAL DR., STE 309, MOBILE, AL, 36608
Administrator’s telephone number 2513441151

Signature of
Role Plan administrator
Date 2010-10-05
Name of individual signing STEPHEN R. SHEPPARD
Role Employer/plan sponsor
Date 2010-10-05
Name of individual signing STEPHEN R. SHEPPARD

Agent

Name Role
SHEPPARD, STEPHEN R Agent

Incorporator

Name Role
SHEPPARD, STEPHEN R Incorporator

Related by officers

SHEPPARD, STEPHEN R

Sheppard Homeworks, LLC

Related by address

MOBILE, AL

A-1 Fence-Craft of America, Inc. AAA Air & Hydraulics of Mobile, Inc. AAA Furniture Warehouse Co., Inc. Bradco, Inc. AAP Distributors, Inc. ABC Comfort, Inc. A B C Fence Industries, Inc. A-C Contracting Company, Inc. AEU Claims, Inc. A G R Co., Incorporated

Date of last update: 01 Aug 2024

Sources: Alabama Secretary of State

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