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R. Rex Payne, M.D., P.C.

Details

Name: R. Rex Payne, M.D., P.C.
Jurisdiction: Alabama
Legal type: Domestic Professional Corporation
Status: Dissolved
Date of registration: 11 Feb 1998 (27 years ago)
Date of dissolution: 27 Oct 2015
Entity Number: 000-193-559
Register Number: 000193559
County: Jefferson
Place of Formation: Jefferson County
Registered Office Street Address: 52 MEDICAL PARK DRIVE EAST, STE 216BIRMINGHAM, AL 35215
Registered Office Street Address ZIP Code: 35215
Authorized Capital: $5,000

Activities PRACTICE OF MEDICINE

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1801072673 2008-01-11 2008-08-18 48 MEDICAL PARK DR E, SUITE 458, BIRMINGHAM, AL, 352353400, US 48 MEDICAL PARK DR E, SUITE 458, BIRMINGHAM, AL, 352353400, US

Contacts
Phone +1 205-838-1811
Fax 2058355958

Authorized person
Name DR. ROBERT REX PAYNE
Role PRESIDENT
Phone 2058381811

Taxonomy
Taxonomy Code 207ND0900X - Dermatopathology Physician
License Number MD.6700
State AL
Is Primary Yes

Other Provider Identifiers
Issuer BC/BS OF ALABAMA
Number 051078860
State AL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
R. REX PAYNE, M. D., P. C. 401(K) PROFIT SHARING PLAN 2012 631194317 2013-09-13 R. REX PAYNE, M. D., P. C. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 2058381811
Plan sponsor’s address 48 MEDICAL PARK DRIVE EAST, SUITE 458, BIRMINGHAM, AL, 352353473

Signature of
Role Plan administrator
Date 2013-09-13
Name of individual signing R. REX PAYNE, M. D.
Role Employer/plan sponsor
Date 2013-09-13
Name of individual signing R. REX PAYNE, M. D.
R. REX PAYNE, M. D. P. C. 401K PROFIT SHARING PLAN 2012 631194317 2013-06-14 R. REX PAYNE, M .D. P. C. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 2058381811
Plan sponsor’s address 48 MEDICAL PARK DRIVE EAST, SUITE 458, BIRMINGHAM, AL, 352353473

Signature of
Role Plan administrator
Date 2013-06-14
Name of individual signing R. REX PAYNE, M.D.
Role Employer/plan sponsor
Date 2013-06-14
Name of individual signing R. REX PAYNE, M.D.
R. REX PAYNE, M. D. P. C. 401K PROFIT SHARING PLAN 2011 631194317 2012-03-30 R. REX PAYNE, M .D. P. C. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 2058381811
Plan sponsor’s address 48 MEDICAL PARK DRIVE EAST, SUITE 458, BIRMINGHAM, AL, 352353473

Plan administrator’s name and address
Administrator’s EIN 631194317
Plan administrator’s name R. REX PAYNE, M .D. P. C.
Plan administrator’s address 48 MEDICAL PARK DRIVE EAST, SUITE 458, BIRMINGHAM, AL, 352353473
Administrator’s telephone number 2058381811

Signature of
Role Plan administrator
Date 2012-03-30
Name of individual signing R. REX PAYNE, M.D.
Role Employer/plan sponsor
Date 2012-03-30
Name of individual signing R. REX PAYNE, M.D.
R. REX PAYNE, M.D. P.C. 401K PROFIT SHARING PLAN 2010 631194317 2011-07-08 R. REX PAYNE, M.D. P.C. 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 2058381811
Plan sponsor’s address 48 MEDICAL PARK DRIVE EAST, SUITE 458, BIRMINGHAM, AL, 352353473

Plan administrator’s name and address
Administrator’s EIN 631194317
Plan administrator’s name R. REX PAYNE, M.D. P.C.
Plan administrator’s address 48 MEDICAL PARK DRIVE EAST, SUITE 458, BIRMINGHAM, AL, 352353473
Administrator’s telephone number 2058381811

Signature of
Role Plan administrator
Date 2011-07-08
Name of individual signing R. REX PAYNE, M.D.
Role Employer/plan sponsor
Date 2011-07-08
Name of individual signing R. REX PAYNE, M.D.
R. REX PAYNE, M.D. P.C. 401K PROFIT SHARING PLAN 2009 631194317 2010-07-21 R. REX PAYNE, M.D. P.C. 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 2058381811
Plan sponsor’s address 48 MEDICAL PARK DRIVE EAST, SUITE 458, BIRMINGHAM, AL, 352353473

Plan administrator’s name and address
Administrator’s EIN 631194317
Plan administrator’s name R. REX PAYNE, M.D. P.C.
Plan administrator’s address 48 MEDICAL PARK DRIVE EAST, SUITE 458, BIRMINGHAM, AL, 352353473
Administrator’s telephone number 2058381811

Signature of
Role Plan administrator
Date 2010-07-21
Name of individual signing R. REX PAYNE, M.D.
Role Employer/plan sponsor
Date 2010-07-21
Name of individual signing R. REX PAYNE, M.D.

Incorporator

Name Role
PAYNE, R REX Incorporator

Agent

Name Role
PAYNE, R REX Agent

Related by officers

PAYNE, R REX

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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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