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Chilton Family Medicine, P.C.

Details

Name: Chilton Family Medicine, P.C.
Jurisdiction: Alabama
Legal type: Domestic Professional Corporation
Status: Exists
Date of registration: 08 Jan 1999 (26 years ago)
Entity Number: 000-200-072
Register Number: 000200072
County: Chilton
Place of Formation: Chilton County
Principal Address: CLANTON, AL
Registered Office Street Address: 107 HEALTH CENTER DRCLANTON, AL 35045
Registered Office Street Address ZIP Code: 35045
Authorized Capital: $500

Activities PROFESSIONAL MEDICAL SERVICES TO THE PUBLIC

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1073389003 2023-11-30 2023-11-30 107 HEALTH CENTER DR, CLANTON, AL, 350452344, US 14 MINNESOTA AVE, THORSBY, AL, 35171, US

Contacts
Phone +1 205-280-1010
Phone +1 256-280-1010

Authorized person
Name JEFFREY F PRICE
Role OWNER
Phone 2052801010

Taxonomy
Taxonomy Code 261QR1300X - Rural Health Clinic/Center
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
CHILTON FAMILY MEDICINE 401(K) PROFIT SHARING PLAN 2023 631216177 2024-10-02 CHILTON FAMILY MEDICINE, P.C. 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621111
Sponsor’s telephone number 2052801010
Plan sponsor’s address 107 HEALTH CENTER DRIVE, CLANTON, AL, 35045

Signature of
Role Plan administrator
Date 2024-10-02
Name of individual signing ALLISON BRECHER
Valid signature Filed with authorized/valid electronic signature
CHILTON FAMILY MEDICINE, P.C. PROFIT SHARING PLAN 2022 631216177 2023-05-22 CHILTON FAMILY MEDICINE, P.C. 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621111
Sponsor’s telephone number 2052801010
Plan sponsor’s address 107 HEALTH CENTER DRIVE, CLANTON, AL, 35045

Signature of
Role Plan administrator
Date 2023-05-22
Name of individual signing JEFFREY PRICE
Role Employer/plan sponsor
Date 2023-05-22
Name of individual signing JEFFREY PRICE
CHILTON FAMILY MEDICINE, P.C. PROFIT SHARING PLAN 2021 631216177 2022-05-23 CHILTON FAMILY MEDICINE, P.C. 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621111
Sponsor’s telephone number 2052801010
Plan sponsor’s address 107 HEALTH CENTER DRIVE, CLANTON, AL, 35045

Signature of
Role Plan administrator
Date 2022-05-23
Name of individual signing JEFFREY PRICE
Role Employer/plan sponsor
Date 2022-05-23
Name of individual signing JEFFREY PRICE
CHILTON FAMILY MEDICINE, P.C. PROFIT SHARING PLAN 2020 631216177 2021-07-27 CHILTON FAMILY MEDICINE, P.C. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621111
Sponsor’s telephone number 2052801010
Plan sponsor’s address 107 HEALTH CENTER DRIVE, CLANTON, AL, 35045

Signature of
Role Plan administrator
Date 2021-07-27
Name of individual signing JEFFREY PRICE
Role Employer/plan sponsor
Date 2021-07-27
Name of individual signing JEFFREY PRICE
CHILTON FAMILY MEDICINE, P.C. PROFIT SHARING PLAN 2019 631216177 2020-04-23 CHILTON FAMILY MEDICINE, P.C. 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621111
Sponsor’s telephone number 2052801010
Plan sponsor’s address 107 HEALTH CENTER DRIVE, CLANTON, AL, 35045

Signature of
Role Plan administrator
Date 2020-04-23
Name of individual signing JEFFREY PRICE
CHILTON FAMILY MEDICINE, P.C. PROFIT SHARING PLAN 2018 631216177 2019-05-13 CHILTON FAMILY MEDICINE, P.C. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621111
Sponsor’s telephone number 2052801010
Plan sponsor’s address 107 HEALTH CENTER DRIVE, CLANTON, AL, 35045

Signature of
Role Plan administrator
Date 2019-05-13
Name of individual signing JEFFREY PRICE
Role Employer/plan sponsor
Date 2019-05-13
Name of individual signing JEFFREY PRICE
CHILTON FAMILY MEDICINE, P.C. PROFIT SHARING PLAN 2017 631216177 2018-04-30 CHILTON FAMILY MEDICINE, P.C. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621111
Sponsor’s telephone number 2052801010
Plan sponsor’s address 107 HEALTH CENTER DRIVE, CLANTON, AL, 35045

Signature of
Role Plan administrator
Date 2018-04-30
Name of individual signing JEFFREY PRICE MD
CHILTON FAMILY MEDICINE, P.C. PROFIT SHARING PLAN 2016 631216177 2017-07-31 CHILTON FAMILY MEDICINE, P.C. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621111
Sponsor’s telephone number 2052801010
Plan sponsor’s address 107 HEALTH CENTER DRIVE, CLANTON, AL, 35045

Signature of
Role Plan administrator
Date 2017-07-31
Name of individual signing JEFFREY PRICE MD
CHILTON FAMILY MEDICINE, P.C. PROFIT SHARING PLAN 2015 631216177 2016-05-24 CHILTON FAMILY MEDICINE, P.C. 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621111
Sponsor’s telephone number 2052801010
Plan sponsor’s address 107 HEALTH CENTER DRIVE, CLANTON, AL, 35045

Signature of
Role Plan administrator
Date 2016-05-24
Name of individual signing JEFFREY PRICE MD
CHILTON FAMILY MEDICINE, P.C. PROFIT SHARING PLAN 2014 631216177 2015-05-15 CHILTON FAMILY MEDICINE, P.C. 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621111
Sponsor’s telephone number 2052801010
Plan sponsor’s address 107 HEALTH CENTER DRIVE, CLANTON, AL, 35045

Signature of
Role Plan administrator
Date 2015-05-15
Name of individual signing JEFFREY PRICE MD

Agent

Name Role
PRICE, JEFFREY FRANK Agent

Incorporator

Name Role
RASMUSSEN, NIEL C Incorporator
PRICE, JEFFERY FRANK Incorporator

Related by officers

PRICE, JEFFREY FRANK

Price Properties, LLC

RASMUSSEN, NIEL C

Niel C. Rasmussen, M.D., P.C. A and N Land, LLC Price Properties, LLC

Related by address

CLANTON, AL

A & R Super Stores, Inc. Davenport Drug, Inc. C & J Enterprises, Inc. C & S Chair Co., Inc. Campbell Auto Parts of Clanton, Inc. Carpet Town, Inc. Chilton Discount Pharmacy, Inc. Clanton Home and Auto Supply, Inc. Whaley's Automotive Supply, Inc. Craigs', Inc.

Date of last update: 01 Aug 2024

Sources: Alabama Secretary of State

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