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Central Alabama Gastroenterology, P.C.

Details

Name: Central Alabama Gastroenterology, P.C.
Jurisdiction: Alabama
Legal type: Domestic Corporation
Status: Exists
Date of registration: 24 Jul 1996 (28 years ago)
Entity Number: 000-181-272
Register Number: 000181272
County: Tallapoosa
Place of Formation: Tallapoosa County
Registered Office Street Address: 3368 HWY 280 SUITE 214ALEXANDER CITY, AL 35010
Registered Office Street Address ZIP Code: 35010
Authorized Capital: $1,000
Paid Share Capital: --

Activities MEDICAL PRACTICE OF GASTROENTEROLOGY

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1538295241 2007-02-26 2010-03-22 3368 HIGHWAY 280, SUITE 214, ALEXANDER CITY, AL, 350103393, US 3368 HIGHWAY 280, SUITE 214, ALEXANDER CITY, AL, 350103393, US

Contacts
Phone +1 256-329-2829
Fax 2563299135

Authorized person
Name DR. DEREK KEITH HOLCOMBE
Role PRESIDENT
Phone 2563292829

Taxonomy
Taxonomy Code 207RG0100X - Gastroenterology Physician
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 529603400
State AL
Issuer BLUE CROSS BLUE SHIELD
Number 51028627
State AL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
CENTRAL ALABAMA GASTROENTEROLOGY, P.C. 401K PSP 2023 631178658 2024-09-30 CENTRAL ALABAMA GASTROENTEROLOGY, P.C. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1997-01-01
Business code 621111
Sponsor’s telephone number 2563292829
Plan sponsor’s mailing address MEDICAL PARK POB, ALEXANDER CITY, AL, 35010
Plan sponsor’s address 3368 HIGHWAY 280, SUITE 107, ALEXANDER CITY, AL, 35010

Number of participants as of the end of the plan year
Active participants 9
Retired or separated participants receiving benefits 1
Number of participants with account balances as of the end of the plan year 6

Signature of
Role Plan administrator
Date 2024-09-30
Name of individual signing ROBERT A. SMITH
Valid signature Filed with authorized/valid electronic signature
CENTRAL ALABAMA GASTROENTEROLOGY, P.C. 401K PSP 2022 631178658 2023-10-11 CENTRAL ALABAMA GASTROENTEROLOGY, P.C. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1997-01-01
Business code 621111
Sponsor’s telephone number 2563292829
Plan sponsor’s mailing address MEDICAL PARK POB, ALEXANDER CITY, AL, 35010
Plan sponsor’s address 3368 HIGHWAY 280, SUITE 107, ALEXANDER CITY, AL, 35010

Number of participants as of the end of the plan year
Active participants 8
Retired or separated participants receiving benefits 1
Number of participants with account balances as of the end of the plan year 6

Signature of
Role Plan administrator
Date 2023-10-11
Name of individual signing ROBERT A. SMITH
Valid signature Filed with authorized/valid electronic signature
CENTRAL ALABAMA GASTROENTEROLOGY, P.C. 401K PSP 2021 631178658 2022-10-12 CENTRAL ALABAMA GASTROENTEROLOGY, P.C. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1997-01-01
Business code 621111
Sponsor’s telephone number 2563292829
Plan sponsor’s mailing address MEDICAL PARK POB, ALEXANDER CITY, AL, 35010
Plan sponsor’s address 3368 HIGHWAY 280, SUITE 107, ALEXANDER CITY, AL, 35010

Number of participants as of the end of the plan year
Active participants 4
Retired or separated participants receiving benefits 1
Number of participants with account balances as of the end of the plan year 5

Signature of
Role Plan administrator
Date 2022-10-12
Name of individual signing ROBERT A. SMITH
Valid signature Filed with authorized/valid electronic signature
CENTRAL ALABAMA GASTROENTEROLOGY, P.C. 401K PSP 2020 631178658 2021-07-27 CENTRAL ALABAMA GASTROENTEROLOGY, P.C. 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1997-01-01
Business code 621111
Sponsor’s telephone number 2563292829
Plan sponsor’s mailing address MEDICAL PARK POB, ALEXANDER CITY, AL, 35010
Plan sponsor’s address 3368 HIGHWAY 280, SUITE 107, ALEXANDER CITY, AL, 35010

Number of participants as of the end of the plan year
Active participants 4
Retired or separated participants receiving benefits 1
Number of participants with account balances as of the end of the plan year 5

Signature of
Role Plan administrator
Date 2021-07-27
Name of individual signing ROBERT SMITH
Valid signature Filed with authorized/valid electronic signature
CENTRAL ALABAMA GASTROENTEROLOGY, P.C. 401K PSP 2019 631178658 2020-10-14 CENTRAL ALABAMA GASTROENTEROLOGY, P.C. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1997-01-01
Business code 621111
Sponsor’s telephone number 2563292829
Plan sponsor’s mailing address MEDICAL PARK POB, ALEXANDER CITY, AL, 35010
Plan sponsor’s address 3368 HIGHWAY 280, SUITE 107, ALEXANDER CITY, AL, 35010

Number of participants as of the end of the plan year
Active participants 2
Retired or separated participants receiving benefits 2
Number of participants with account balances as of the end of the plan year 2

Signature of
Role Plan administrator
Date 2020-10-13
Name of individual signing ROBERT A. SMITH
Valid signature Filed with authorized/valid electronic signature
CENTRAL ALABAMA GASTROENTEROLOGY, P.C. 401K PSP 2018 631178658 2019-06-24 CENTRAL ALABAMA GASTROENTEROLOGY, P.C. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1997-01-01
Business code 621111
Sponsor’s telephone number 2563292829
Plan sponsor’s mailing address 3368 HIGHWAY 280, SUITE 107, ALEXANDER CITY, AL, 35010
Plan sponsor’s address 3368 HIGHWAY 280, SUITE 107, ALEXANDER CITY, AL, 35010

Number of participants as of the end of the plan year
Active participants 4
Retired or separated participants receiving benefits 2
Number of participants with account balances as of the end of the plan year 6

Signature of
Role Plan administrator
Date 2019-04-18
Name of individual signing ROBERT A. SMITH
Valid signature Filed with authorized/valid electronic signature
CENTRAL ALABAMA GASTROENTEROLOGY, P.C. 401K PSP 2017 631178658 2018-07-30 CENTRAL ALABAMA GASTROENTEROLOGY, P.C. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1997-01-01
Business code 621111
Sponsor’s telephone number 2563292829
Plan sponsor’s mailing address 3368 HIGHWAY 280, SUITE 107, ALEXANDER CITY, AL, 35010
Plan sponsor’s address 3368 HIGHWAY 280, SUITE 107, ALEXANDER CITY, AL, 35010

Number of participants as of the end of the plan year
Active participants 6
Number of participants with account balances as of the end of the plan year 6

Signature of
Role Plan administrator
Date 2018-07-25
Name of individual signing ROBERT A. SMITH
Valid signature Filed with authorized/valid electronic signature
CENTRAL ALABAMA GASTROENTEROLOGY, P.C. 401K PSP 2016 631178658 2017-10-14 CENTRAL ALABAMA GASTROENTEROLOGY, P.C. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1997-01-01
Business code 621111
Sponsor’s telephone number 2563292829
Plan sponsor’s mailing address 3368 HIGHWAY 280, SUITE 107, ALEXANDER CITY, AL, 35010
Plan sponsor’s address 3368 HIGHWAY 280, SUITE 107, ALEXANDER CITY, AL, 35010

Number of participants as of the end of the plan year
Active participants 6
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 6

Signature of
Role Plan administrator
Date 2017-10-14
Name of individual signing ROBERT A. SMITH
Valid signature Filed with authorized/valid electronic signature
CENTRAL ALABAMA GASTROENTEROLOGY, P.C. 401K PSP 2015 631178658 2016-07-14 CENTRAL ALABAMA GASTROENTEROLOGY, P.C. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1997-01-01
Business code 621111
Sponsor’s telephone number 2563292829
Plan sponsor’s mailing address 3368 HIGHWAY 280, SUITE 107, ALEXANDER CITY, AL, 35010
Plan sponsor’s address 3368 HIGHWAY 280, SUITE 107, ALEXANDER CITY, AL, 35010

Number of participants as of the end of the plan year
Active participants 5
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 5
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2016-07-12
Name of individual signing ROBERT A. SMITH
Valid signature Filed with authorized/valid electronic signature
CENTRAL ALABAMA GASTROENTEROLOGY, P.C. 401K PSP 2014 631178658 2015-10-09 CENTRAL ALABAMA GASTROENTEROLOGY, P.C. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1997-01-01
Business code 621111
Sponsor’s telephone number 2563292829
Plan sponsor’s mailing address 3368 HIGHWAY 280, SUITE 107, ALEXANDER CITY, AL, 35010
Plan sponsor’s address 3368 HIGHWAY 280, SUITE 107, ALEXANDER CITY, AL, 35010

Number of participants as of the end of the plan year
Active participants 5
Retired or separated participants receiving benefits 2
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 5

Signature of
Role Plan administrator
Date 2015-10-08
Name of individual signing ROBERT A. SMITH
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role
HOLCOMBE, D K Agent

Incorporator

Name Role Address
LYLE, JOHN F III Incorporator PO BOX 2329FAIRHOPE, AL 36533

Related by officers

LYLE, JOHN F III

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Related by address

No related companies by address

Date of last update: 01 Aug 2024

Sources: Alabama Secretary of State

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