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Surgical Associates of Eastern Shore, P.C.

Details

Name: Surgical Associates of Eastern Shore, P.C.
Jurisdiction: Alabama
Legal type: Domestic Professional Corporation
Status: Dissolved
Date of registration: 30 Jul 1997 (27 years ago)
Date of dissolution: 17 Jun 2021
Entity Number: 000-189-559
Register Number: 000189559
County: Baldwin
Place of Formation: Baldwin County
Principal Address: FAIRHOPE, AL
Registered Office Street Address: 22453 SEA CLIFF DRFAIRHOPE, AL 36532
Registered Office Street Address ZIP Code: 36532
Authorized Capital: $5,000

Activities PROFESSIONAL MEDICAL SERVICES

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1528153053 2006-10-03 2016-05-18 767 MIDDLE ST, FAIRHOPE, AL, 36532, US 767 MIDDLE ST, FAIRHOPE, AL, 36532, US

Contacts
Phone +1 251-990-9191
Fax 2519909189

Authorized person
Name JIMMIE G GAVRAS
Role PHYSICIAN
Phone 2519909191

Taxonomy
Taxonomy Code 174400000X - Specialist
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 529702280
State AL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
SURGICAL ASSOCIATES OF EASTERN SHORE P. C. 401(K) PROFIT SHARING PLAN 2018 721379081 2019-11-25 SURGICAL ASSOCIATES OF EASTERN SHORE P.C. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1998-01-01
Business code 621111
Sponsor’s telephone number 2519909116
Plan sponsor’s address 188 HOSPITAL DR SUITE 205, FAIRHOPE, AL, 36532

Signature of
Role Plan administrator
Date 2019-11-25
Name of individual signing JIMMIE GAVRAS
Role Employer/plan sponsor
Date 2019-11-25
Name of individual signing JIMMIE GAVRAS
SURGICAL ASSOCIATES OF EASTERN SHORE P.C. 401K PROFIT SHARING PLAN 2018 721379081 2019-02-07 SURGICAL ASSOCIATES OF EASTERN SHORE P.C. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1998-01-01
Business code 621111
Sponsor’s telephone number 2519909116
Plan sponsor’s address 188 HOSPITAL DR SUITE 205, FAIRHOPE, AL, 36532

Signature of
Role Plan administrator
Date 2019-02-07
Name of individual signing JIMMIE GAVRAS
Role Employer/plan sponsor
Date 2019-02-07
Name of individual signing JIMMIE GAVRAS
SURGICAL ASSOCIATES OF EASTERN SHORE P.C. 401K PROFIT SHARING PLAN 2017 721379081 2018-02-08 SURGICAL ASSOCIATES OF EASTERN SHORE P.C. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1998-01-01
Business code 621111
Sponsor’s telephone number 2519909116
Plan sponsor’s address 188 HOSPITAL DR SUITE 205, FAIRHOPE, AL, 36532

Signature of
Role Plan administrator
Date 2018-02-08
Name of individual signing JIMMIE GAVRAS
SURGICAL ASSOCIATES OF EASTERN SHORE P.C. 401K PROFIT SHARING PLAN 2016 721379081 2017-02-09 SURGICAL ASSOCIATES OF EASTERN SHORE P.C. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1998-01-01
Business code 621111
Sponsor’s telephone number 2519909116
Plan sponsor’s address 767 MIDDLE STREET, FAIRHOPE, AL, 36532

Signature of
Role Plan administrator
Date 2017-02-09
Name of individual signing JIMMIE GAVRAS
SURGICAL ASSOCIATES OF EASTERN SHORE P.C. 401K PROFIT SHARING PLAN 2015 721379081 2016-02-02 SURGICAL ASSOCIATES OF EASTERN SHORE P.C. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1998-01-01
Business code 621111
Sponsor’s telephone number 2519909116
Plan sponsor’s address 767 MIDDLE STREET, FAIRHOPE, AL, 36532

Signature of
Role Plan administrator
Date 2016-02-02
Name of individual signing JIMMIE GAVRAS
SURGICAL ASSOCIATES OF EASTERN SHORE P.C. 401K PROFIT SHARING PLAN 2014 721379081 2015-02-16 SURGICAL ASSOCIATES OF EASTERN SHORE P.C. 8
Three-digit plan number (PN) 001
Effective date of plan 1998-01-01
Business code 621111
Sponsor’s telephone number 2519909116
Plan sponsor’s address P.O. BOX 1105, FAIRHOPE, AL, 35533

Signature of
Role Plan administrator
Date 2015-02-16
Name of individual signing CHARLES B. SMITH
SURGICAL ASSOCIATES OF EASTERN SHORE P.C. 401K PROFIT SHARING PLAN 2014 721379081 2015-06-16 SURGICAL ASSOCIATES OF EASTERN SHORE P.C. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1998-01-01
Business code 621111
Sponsor’s telephone number 2519909116
Plan sponsor’s address P.O. BOX 1105, FAIRHOPE, AL, 35533

Signature of
Role Plan administrator
Date 2015-06-16
Name of individual signing CHARLES B. SMITH
SURGICAL ASSOCIATES OF EASTERN SHORE P.C. 401K PROFIT SHARING PLAN 2013 721379081 2014-02-05 SURGICAL ASSOCIATES OF EASTERN SHORE P.C. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1998-01-01
Business code 621111
Sponsor’s telephone number 2519909116
Plan sponsor’s address P.O. BOX 1105, FAIRHOPE, AL, 35533

Signature of
Role Plan administrator
Date 2014-02-05
Name of individual signing CHARLES B. SMITH
Role Employer/plan sponsor
Date 2014-02-05
Name of individual signing CHARLES B SMITH
SURGICAL ASSOCIATES OF EASTERN SHORE P.C. 401K PROFIT SHARING PLAN 2012 721379081 2013-02-18 SURGICAL ASSOCIATES OF EASTERN SHORE P.C. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1998-01-01
Business code 621111
Sponsor’s telephone number 2519909116
Plan sponsor’s address P.O. BOX 1105, FAIRHOPE, AL, 35533

Signature of
Role Plan administrator
Date 2013-02-18
Name of individual signing CHARLES B. SMITH
SURGICAL ASSOCIATES OF EASTERN SHORE P.C. 401K PROFIT SHARING PLAN 2011 721379081 2012-03-22 SURGICAL ASSOCIATES OF EASTERN SHORE P.C. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1998-01-01
Business code 621111
Sponsor’s telephone number 2519909116
Plan sponsor’s address P.O. BOX 1105, FAIRHOPE, AL, 35533

Plan administrator’s name and address
Administrator’s EIN 721379081
Plan administrator’s name SURGICAL ASSOCIATES OF EASTERN SHORE P.C.
Plan administrator’s address P.O. BOX 1105, FAIRHOPE, AL, 35533
Administrator’s telephone number 2519909116

Signature of
Role Plan administrator
Date 2012-03-22
Name of individual signing CHARLES B. SMITH

Incorporator

Name Role
SMITH, CHARLES B Incorporator
MCKISSACK, RANDALL L Incorporator

Agent

Name Role
SMITH, CHARLES B Agent

Related by officers

SMITH, CHARLES B

S & W Minicomputers, Inc. Lachele's, Inc. Welded Wood, LLC S & M Properties, L.L.C. Mountain Valley Properties, LLC Brooklane Properties, LLC City Delivery Service, Inc.

MCKISSACK, RANDALL L

Eastern Shore Surgical Clinic, P.C.

Related by address

FAIRHOPE, AL

ACS Leasing Co., Inc. Alabama Aircraft, Inc. Bama Jewelers, Inc. Baron's Motel & Restaurant, Inc. Barr-Hoffren Enterprises, Inc. Bay Hill, Inc. Bay Nautical Supply Co., Inc. Bayview Services, Inc. The Colony Shop, Inc. Crawford Beverage, Inc.

Date of last update: 01 Aug 2024

Sources: Alabama Secretary of State

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