Alexander City Dermatology, P.C.

Details

Name:	Alexander City Dermatology, P.C.
Jurisdiction:	Alabama
Legal type:	Domestic Professional Corporation
Status:	Exists
Date of registration:	31 Mar 1997 (28 years ago)
Entity Number:	000-186-769
Register Number:	000186769
County:	Tallapoosa
Place of Formation:	Tallapoosa County
Registered Office Street Address:	RUSSELL HOSP MED PK OFFICE BLDG STE 208ALEXANDER CITY, AL 35010
Registered Office Street Address ZIP Code:	35010
Authorized Capital:	$1,000

Activities DERMATOLOGY

National Provider Identifier

NPI

Enumeration Date

Last Update Date

Mailing Address

Practice Location Address

1932389715

2007-11-08

2008-04-20

125 ALISON DR, SUITE 8, ALEXANDER CITY, AL, 350104469, US

125 ALISON DR, SUITE 8, ALEXANDER CITY, AL, 350104469, US

Contacts

Phone	+1 256-409-2159
Fax	3345017031

Authorized person

Name	DR. STEVEN LYNN MACKEY
Role	PRESIDENT
Phone	2564092159

Taxonomy

Taxonomy Code	207N00000X - Dermatology Physician
License Number	14427
State	AL
Is Primary	Yes

Other Provider Identifiers

Issuer	CIGNA
Number	0731200138
State	AL
Issuer	MEDICAID
Number	000038661
State	AL
Issuer	AETNA
Number	0005960521
State	AL
Issuer	BLUE CROSS
Number	51038661
State	AL
Issuer	MEDICAID
Number	529703210
State	AL

form 5500

Plan Name

Plan Year

EIN/PN

Received

Sponsor

Total number of participants

ALEXANDER CITY DERMATOLOGY, P. C. 401(K) PROFIT SHARING PLAN

2022

721355996

2023-09-29

ALEXANDER CITY DERMATOLOGY, P. C.

17

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2006-01-01
Business code	621399
Sponsor’s telephone number	2564092159
Plan sponsor’s address	125 ALISON DRIVE, SUITE 8, ALEXANDER CITY, AL, 35010

ALEXANDER CITY DERMATOLOGY, P. C. 401(K) PROFIT SHARING PLAN

2021

721355996

2022-10-14

ALEXANDER CITY DERMATOLOGY, P. C.

20

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2006-01-01
Business code	621399
Sponsor’s telephone number	2564092159
Plan sponsor’s address	125 ALISON DRIVE, SUITE 8, ALEXANDER CITY, AL, 35010

ALEXANDER CITY DERMATOLOGY, P. C. 401(K) PROFIT SHARING PLAN

2021

721355996

2022-10-14

ALEXANDER CITY DERMATOLOGY, P. C.

20

Three-digit plan number (PN)	001
Effective date of plan	2006-01-01
Business code	621399
Sponsor’s telephone number	2564092159
Plan sponsor’s address	125 ALISON DRIVE, SUITE 8, ALEXANDER CITY, AL, 35010

ALEXANDER CITY DERMATOLOGY, P. C. 401(K) PROFIT SHARING PLAN

2020

721355996

2021-10-13

ALEXANDER CITY DERMATOLOGY, P. C.

20

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2006-01-01
Business code	621399
Sponsor’s telephone number	2564092159
Plan sponsor’s address	125 ALISON DRIVE, SUITE 8, ALEXANDER CITY, AL, 35010

ALEXANDER CITY DERMATOLOGY, P. C. 401(K) PROFIT SHARING PLAN

2019

721355996

2020-07-16

ALEXANDER CITY DERMATOLOGY, P. C.

21

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2006-01-01
Business code	621399
Sponsor’s telephone number	2564092159
Plan sponsor’s address	125 ALISON DRIVE, SUITE 8, ALEXANDER CITY, AL, 35010

ALEXANDER CITY DERMATOLOGY, P. C. 401(K) PROFIT SHARING PLAN

2018

721355996

2019-10-08

ALEXANDER CITY DERMATOLOGY, P. C.

18

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2006-01-01
Business code	621399
Sponsor’s telephone number	2564092159
Plan sponsor’s address	125 ALISON DRIVE, SUITE 8, ALEXANDER CITY, AL, 35010

ALEXANDER CITY DERMATOLOGY, P. C. 401(K) PROFIT SHARING PLAN

2017

721355996

2018-10-15

ALEXANDER CITY DERMATOLOGY, P. C.

20

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2006-01-01
Business code	621399
Sponsor’s telephone number	2564092159
Plan sponsor’s address	125 ALISON DRIVE, SUITE 8, ALEXANDER CITY, AL, 35010

Agent

Name	Role
MACKEY, STEVEN L	Agent

Incorporator

Name	Role
MACKEY, STEVEN L	Incorporator

Date of last update: 01 Aug 2024

Sources: Alabama Secretary of State