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Alabama Digestive Disorders Center, P.C.

Details

Name: Alabama Digestive Disorders Center, P.C.
Jurisdiction: Alabama
Legal type: Domestic Professional Corporation
Status: Exists
Date of registration: 29 Oct 1997 (27 years ago)
Entity Number: 000-191-350
Register Number: 000191350
County: Madison
Place of Formation: Madison County
Registered Office Street Address: 333 WHITESPORT, STE 205HUNTSVILLE, AL 35801
Registered Office Street Address ZIP Code: 35801
Authorized Capital: $140

Activities GASTROENTEROLOGY PRACTICE

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1912946385 2006-06-04 2022-07-05 4601 WHITESBURG DR SE STE 101, HUNTSVILLE, AL, 358021677, US 4601 WHITESBURG DR SE STE 101, HUNTSVILLE, AL, 358021677, US

Contacts
Phone +1 256-882-7888
Fax 2568827886

Authorized person
Name SMITA S SHAH
Role GASTROENTEROLOGIST
Phone 2568827888

Taxonomy
Taxonomy Code 207RG0100X - Gastroenterology Physician
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 529801520
State AL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
ETF ADVISOR K MEP PLAN 2021 631187064 2022-07-27 ALABAMA DIGESTIVE DISORDERS CENTER 7
File View Page
Three-digit plan number (PN) 336
Effective date of plan 1999-10-01
Business code 621111
Sponsor’s telephone number 2568827888
Plan sponsor’s address 4601 WHITESBURG DRIVE, SUITE 101, HUNTSVILLE, AL, 35802

Plan administrator’s name and address
Administrator’s EIN 813799174
Plan administrator’s name FIDUCIARY WISE
Plan administrator’s address 2487 S. GILBERT ROAD, SUITE 106-455, GILBERT, AZ, 85295
Administrator’s telephone number 7143312623

Signature of
Role Plan administrator
Date 2022-07-27
Name of individual signing KRISTI DALLEY
ETF ADVISOR K MEP PLAN 2020 631187064 2021-07-26 ALABAMA DIGESTIVE DISORDERS CENTER 8
File View Page
Three-digit plan number (PN) 336
Effective date of plan 1999-10-01
Business code 621111
Sponsor’s telephone number 2568827888
Plan sponsor’s address 4601 WHITESBURG DRIVE, SUITE 101, HUNTSVILLE, AL, 35802

Plan administrator’s name and address
Administrator’s EIN 813799174
Plan administrator’s name FIDUCIARY WISE
Plan administrator’s address 2487 S. GILBERT ROAD, SUITE 106-455, GILBERT, AZ, 85295
Administrator’s telephone number 7143312623

Signature of
Role Plan administrator
Date 2021-07-26
Name of individual signing KRISTI DALLEY
ETF ADVISOR K MEP PLAN 2019 631187064 2020-07-23 ALABAMA DIGESTIVE DISORDERS CENTER 9
File View Page
Three-digit plan number (PN) 336
Effective date of plan 1999-10-01
Business code 621111
Sponsor’s telephone number 2568827888
Plan sponsor’s address 4601 WHITESBURG DRIVE, SUITE 101, HUNTSVILLE, AL, 35802

Plan administrator’s name and address
Administrator’s EIN 813799174
Plan administrator’s name FIDUCIARY WISE
Plan administrator’s address 2487 S. GILBERT ROAD, SUITE 106-455, GILBERT, AZ, 85295
Administrator’s telephone number 7143312623

Signature of
Role Plan administrator
Date 2020-07-23
Name of individual signing KRISTI DALLEY
ETF ADVISOR K MEP PLAN 2018 631187064 2020-07-23 ALABAMA DIGESTIVE DISORDERS CENTER 9
File View Page
Three-digit plan number (PN) 336
Effective date of plan 1999-10-01
Business code 621111
Sponsor’s telephone number 2568827888
Plan sponsor’s address 4601 WHITESBURG DRIVE, SUITE 101, HUNTSVILLE, AL, 35802

Plan administrator’s name and address
Administrator’s EIN 813799174
Plan administrator’s name FIDUCIARY WISE
Plan administrator’s address 2487 S. GILBERT ROAD, SUITE 106-455, GILBERT, AZ, 85295
Administrator’s telephone number 7143312623

Signature of
Role Plan administrator
Date 2020-07-23
Name of individual signing KRISTI DALLEY
ETF ADVISOR K MEP PLAN 2018 631187064 2019-07-22 ALABAMA DIGESTIVE DISORDERS CENTER 9
Three-digit plan number (PN) 336
Effective date of plan 1999-10-01
Business code 621111
Sponsor’s telephone number 2568827888
Plan sponsor’s address 4601 WHITESBURG DRIVE, SUITE 101, HUNTSVILLE, AL, 35802

Plan administrator’s name and address
Administrator’s EIN 813799174
Plan administrator’s name FIDUCIARY WISE
Plan administrator’s address 2487 S. GILBERT ROAD, SUITE 106-455, GILBERT, AZ, 85295
Administrator’s telephone number 7143312623

Signature of
Role Plan administrator
Date 2019-07-22
Name of individual signing KRISTI DALLEY
ETF ADVISOR K MEP PLAN 2017 631187064 2018-07-23 ALABAMA DIGESTIVE DISORDERS CENTER 5
File View Page
Three-digit plan number (PN) 336
Effective date of plan 1999-10-01
Business code 621111
Sponsor’s telephone number 2568827888
Plan sponsor’s address 4601 WHITESBURG DRIVE, SUITE 101, HUNTSVILLE, AL, 35802

Plan administrator’s name and address
Administrator’s EIN 813799174
Plan administrator’s name FIDUCIARY WISE
Plan administrator’s address 2487 S. GILBERT ROAD, SUITE 106-455, GILBERT, AZ, 85295
Administrator’s telephone number 7143312623

Signature of
Role Plan administrator
Date 2018-07-23
Name of individual signing T R BICK

Agent

Name Role Address
SHAH, SMITA S Agent 4601 WHITESBURG DR SE SUITE 101HUNTSVILLE, AL 35802-1677

Incorporator

Name Role Address
SHAH, SMITA S Incorporator 4601 WHITESBURG DR SE SUITE 101HUNTSVILLE, AL 35802-1677

Related by officers

SHAH, SMITA S

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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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