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Pediatric Rural Health Clinics, Inc.

Details

Name: Pediatric Rural Health Clinics, Inc.
Jurisdiction: Alabama
Legal type: Domestic Corporation
Status: Exists
Date of registration: 25 Nov 1997 (27 years ago)
Entity Number: 000-191-920
Register Number: 000191920
County: Montgomery
Place of Formation: Montgomery County
Principal Address: MONTGOMERY, AL
Registered Office Street Address: 2167 NORMANDIE DRIVEMONTGOMERY, AL 36111
Registered Office Street Address ZIP Code: 36111
Authorized Capital: $5,000

Activities RURAL HEALTH CLINICS

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1992742860 2006-06-01 2012-10-11 46 L V STABLER DR, GREENVILLE, AL, 360373804, US 46 L V STABLER DR, GREENVILLE, AL, 360373804, US

Contacts
Phone +1 334-382-9760
Fax 3343839331

Authorized person
Name MRS. ANNE KEEN
Role VP OF OPERATIONS
Phone 3343829760

Taxonomy
Taxonomy Code 208000000X - Pediatrics Physician
License Number 00006213
State AL
Is Primary No
Taxonomy Code 208000000X - Pediatrics Physician
License Number 00024891
State AL
Is Primary No
Taxonomy Code 208000000X - Pediatrics Physician
License Number 00006634
State AL
Is Primary No
Taxonomy Code 363LP0200X - Pediatric Nurse Practitioner
License Number 1-065300
State AL
Is Primary Yes
Taxonomy Code 363LP0200X - Pediatric Nurse Practitioner
License Number 01-069655
State AL
Is Primary No

Other Provider Identifiers
Issuer MEDICAID
Number 541003905
State AL
Issuer MEDICAID
Number 529800610
State AL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
PEDIATRIC RURAL HEALTH CLINICS, INC. 401(K) PROFIT SHARING PLAN 2023 631188627 2024-02-14 PEDIATRIC RURAL HEALTH CLINICS, INC. 23
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-01-01
Business code 621498
Sponsor’s telephone number 3343829760
Plan sponsor’s address 46 L.V. STABLER DRIVE, GREENVILLE, AL, 36037

Signature of
Role Plan administrator
Date 2024-02-14
Name of individual signing LISA DICKS
Role Employer/plan sponsor
Date 2024-02-14
Name of individual signing LISA DICKS
PEDIATRIC RURAL HEALTH CLINICS, INC. 401(K) PROFIT SHARING PLAN 2022 631188627 2023-05-03 PEDIATRIC RURAL HEALTH CLINICS, INC. 23
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-01-01
Business code 621498
Sponsor’s telephone number 3343829760
Plan sponsor’s address 46 L.V. STABLER DRIVE, GREENVILLE, AL, 36037

Signature of
Role Plan administrator
Date 2023-03-01
Name of individual signing LISA DICKS
Role Employer/plan sponsor
Date 2023-03-01
Name of individual signing LISA DICKS
PEDIATRIC RURAL HEALTH CLINICS, INC. 401(K) PROFIT SHARING PLAN 2021 631188627 2022-03-02 PEDIATRIC RURAL HEALTH CLINICS, INC. 20
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-01-01
Business code 621498
Sponsor’s telephone number 3343829760
Plan sponsor’s address 46 L.V. STABLER DRIVE, GREENVILLE, AL, 36037

Signature of
Role Plan administrator
Date 2022-03-02
Name of individual signing LISA DICKS
Role Employer/plan sponsor
Date 2022-03-02
Name of individual signing LISA DICKS
PEDIATRIC RURAL HEALTH CLINICS, INC. 401(K) PROFIT SHARING PLAN 2020 631188627 2021-03-31 PEDIATRIC RURAL HEALTH CLINICS, INC. 17
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-01-01
Business code 621498
Sponsor’s telephone number 3343829760
Plan sponsor’s address 46 L.V. STABLER DR., GREENVILLE, AL, 36037

Signature of
Role Plan administrator
Date 2021-03-31
Name of individual signing LISA DICKS
Role Employer/plan sponsor
Date 2021-03-31
Name of individual signing LISA DICKS
PEDIATRIC RURAL HEALTH CLINICS, INC. 401(K) PROFIT SHARING PLAN 2019 631188627 2020-03-10 PEDIATRIC RURAL HEALTH CLINICS, INC. 18
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-01-01
Business code 621498
Sponsor’s telephone number 3343829760
Plan sponsor’s address 46 L.V. STABLER DR., GREENVILLE, AL, 36037

Signature of
Role Plan administrator
Date 2020-03-10
Name of individual signing LISA DICKS
Role Employer/plan sponsor
Date 2020-03-10
Name of individual signing LISA DICKS
PEDIATRIC RURAL HEALTH CLINICS, INC. 401(K) PROFIT SHARING PLAN 2018 631188627 2019-01-23 PEDIATRIC RURAL HEALTH CLINICS, INC. 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-01-01
Business code 621498
Sponsor’s telephone number 3343829760
Plan sponsor’s address 46 L.V. STABLER DR., GREENVILLE, AL, 36037

Signature of
Role Plan administrator
Date 2019-01-23
Name of individual signing LISA DICKS
Role Employer/plan sponsor
Date 2019-01-23
Name of individual signing LISA DICKS

Agent

Name Role
SUMNERS, JOHN H Agent

Incorporator

Name Role
SUMNERS, JOHN H Incorporator

Related by officers

SUMNERS, JOHN H

United Marketing Network, Inc. Pediatric Properties, L.L.P.

Related by address

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Date of last update: 01 Aug 2024

Sources: Alabama Secretary of State

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