Gulf Shores Pediatrics, P.C.

Details

Name:	Gulf Shores Pediatrics, P.C.
Jurisdiction:	Alabama
Legal type:	Domestic Professional Corporation
Status:	Exists
Date of registration:	21 Dec 1998 (26 years ago)
Entity Number:	000-199-703
Register Number:	000199703
County:	Baldwin
Place of Formation:	Baldwin County
Registered Office Street Address:	232 OFFICE PARK DRIVEGULF SHORES, AL 36542
Registered Office Street Address ZIP Code:	36542
Authorized Capital:	$25,000

Activities PROVIDING MEDICAL CARE & TREATMENT TO CHILDREN

National Provider Identifier

NPI

Enumeration Date

Last Update Date

Mailing Address

Practice Location Address

1932121845

2006-07-24

2020-08-22

232 OFFICE PARK DR., GULF SHORES, AL, 36542, US

Contacts

Phone	+1 251-968-2323
Fax	2519682624

Authorized person

Name	DR. KATHLEEN C LAVLIE
Role	BUSINESS PRESIDENT
Phone	2519682323

Taxonomy

Taxonomy Code	208000000X - Pediatrics Physician
License Number	22320
State	AL
Is Primary	Yes

Other Provider Identifiers

Issuer	BCBS
Number	39807
State	AL

form 5500

Plan Name

Plan Year

EIN/PN

Received

Sponsor

Total number of participants

GULF SHORES PEDIATRICS, P. C. 401(K) PLAN

2020

631219052

2021-10-22

GULF SHORES PEDIATRICS, P.C.

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2002-06-01
Business code	621111
Sponsor’s telephone number	3346552161
Plan sponsor’s address	232 OFFICE PARK DR, GULF SHORES, AL, 36542

Signature of

Role	Plan administrator
Date	2021-10-21
Name of individual signing	DR. AMANDA GOLD

GULF SHORES PEDIATRICS, P. C. 401(K) PLAN

2020

631219052

2021-06-21

GULF SHORES PEDIATRICS, P.C.

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2002-06-01
Business code	621111
Sponsor’s telephone number	3346552161
Plan sponsor’s address	232 OFFICE PARK DR, GULF SHORES, AL, 36542

Signature of

Role	Plan administrator
Date	2021-06-21
Name of individual signing	AMANDA GOLD

Role	Employer/plan sponsor
Date	2021-06-21
Name of individual signing	AMANDA GOLD

GULF SHORES PEDIATRICS, P. C. 401(K) PLAN

2019

631219052

2020-07-15

GULF SHORES PEDIATRICS, P.C.

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2002-06-01
Business code	621111
Sponsor’s telephone number	3346552161
Plan sponsor’s address	232 OFFICE PARK DR, GULF SHORES, AL, 36542

Signature of

Role	Plan administrator
Date	2020-07-15
Name of individual signing	AMANDA GOLD

Role	Employer/plan sponsor
Date	2020-07-15
Name of individual signing	AMANDA GOLD

GULF SHORES PEDIATRICS, P. C. 401(K) PLAN

2018

631219052

2019-06-07

GULF SHORES PEDIATRICS, P.C.

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2002-06-01
Business code	621111
Sponsor’s telephone number	2519682323
Plan sponsor’s address	232 OFFICE PARK DR, GULF SHORES, AL, 36542

Signature of

Role	Plan administrator
Date	2019-06-07
Name of individual signing	KATHLEEN C LOVLIE

Role	Employer/plan sponsor
Date	2019-06-07
Name of individual signing	KATHLEEN C LOVLIE

GULF SHORES PEDIATRICS, P. C. 401(K) PLAN

2017

631219052

2018-07-02

GULF SHORES PEDIATRICS, P.C.

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2002-06-01
Business code	621111
Sponsor’s telephone number	2519682323
Plan sponsor’s address	232 OFFICE PARK DR, GULF SHORES, AL, 36542

Signature of

Role	Plan administrator
Date	2018-07-01
Name of individual signing	KATHLEEN C LOVLIE

Role	Employer/plan sponsor
Date	2018-07-01
Name of individual signing	KATHLEEN C LOVLIE

GULF SHORES PEDIATRICS, P. C. 401(K) PLAN

2016

631219052

2017-05-02

GULF SHORES PEDIATRICS, P.C.

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2002-06-01
Business code	621111
Sponsor’s telephone number	2519682323
Plan sponsor’s address	232 OFFICE PARK DR, GULF SHORES, AL, 36542

Signature of

Role	Plan administrator
Date	2017-05-02
Name of individual signing	KATHLEEN LOVLIE

Role	Employer/plan sponsor
Date	2017-05-02
Name of individual signing	KATHLEEN LOVLIE

GULF SHORES PEDIATRICS, P. C. 401(K) PLAN

2015

631219052

2016-05-24

GULF SHORES PEDIATRICS, P.C.

Three-digit plan number (PN)	001
Effective date of plan	2002-06-01
Business code	621111
Sponsor’s telephone number	2519682323
Plan sponsor’s address	232 OFFICE PARK DR, GULF SHORES, AL, 36542

Signature of

Role	Plan administrator
Date	2016-05-23
Name of individual signing	KATHLEEN LOVLIE

GULF SHORES PEDIATRICS, P.C. 401(K) PLAN

2014

631219052

2015-07-19

GULF SHORES PEDIATRICS, P.C.

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2002-06-01
Business code	621111
Sponsor’s telephone number	2519682323
Plan sponsor’s address	232 OFFICE PARK DRIVE, GULF SHORES, AL, 36542

Signature of

Role	Plan administrator
Date	2015-07-19
Name of individual signing	KATHLEEN C LOVLIE

Role	Employer/plan sponsor
Date	2015-07-19
Name of individual signing	KATHLEEN C LOVLIE

GULF SHORES PEDIATRICS, P.C. 401(K) PLAN

2013

631219052

2014-07-08

GULF SHORES PEDIATRICS, P.C.

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2002-06-01
Business code	621111
Sponsor’s telephone number	2519682323
Plan sponsor’s address	232 OFFICE PARK DRIVE, GULF SHORES, AL, 36542

Signature of

Role	Plan administrator
Date	2014-07-08
Name of individual signing	KATHLEEN LOVLIE

Role	Employer/plan sponsor
Date	2014-07-08
Name of individual signing	KATHLEEN LOVLIE

GULF SHORES PEDIATRICS, P.C. 401(K) PLAN

2012

631219052

2013-06-05

GULF SHORES PEDIATRICS, P.C.

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2002-06-01
Business code	621111
Sponsor’s telephone number	2519682323
Plan sponsor’s address	232 OFFICE PARK DRIVE, GULF SHORES, AL, 36542

Signature of

Role	Plan administrator
Date	2013-06-05
Name of individual signing	KATHLEEN C LOVLIE

Role	Employer/plan sponsor
Date	2013-06-05
Name of individual signing	KATHLEEN C LOVLIE

Agent

Name	Role
GOLD, AMANDA	Agent

Incorporator

Name	Role
LOVLIE, KATHLEEN C	Incorporator

Date of last update: 01 Aug 2024

Sources: Alabama Secretary of State

Gulf Shores Pediatrics, P.C.

Details

National Provider Identifier

form 5500

Agent

Incorporator

Related by officers

Related by address