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Tennessee River Eye Clinic, P.C.

Details

Name: Tennessee River Eye Clinic, P.C.
Jurisdiction: Alabama
Legal type: Domestic Professional Corporation
Status: Exists
Date of registration: 30 Mar 1999 (26 years ago) (Companies founded in March 1999)
Entity Number: 000-201-875
Register Number: 000201875
ZIP code: 35660 (Companies in Colbert, 35660)
County: Colbert
Place of Formation: Colbert County
Principal Address: SHEFFIELD, AL
Registered Office Street Address: 1111 S RALEIGH AVESHEFFIELD, AL 35660
Authorized Capital: $1,000
Paid Share Capital: $1,000

Activities PROFESSIONAL MEDICAL SERVICES

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1548310741 2007-01-11 2022-04-13 1110 S. MONTGOMERY AVE, HELEN KELLER HOSPITAL CAMPUS, SHEFFIELD, AL, 356606350, US 1110 S. MONTGOMERY AVE, HELEN KELLER HOSPITAL CAMPUS, SHEFFIELD, AL, 356606350, US

Contacts
Phone +1 256-381-2020
Fax 2563817754

Authorized person
Name MARK A KASSELS
Role OWNER PRESIDENT
Phone 2563812020

Taxonomy
Taxonomy Code 207W00000X - Ophthalmology Physician
License Number 16162
State AL
Is Primary Yes

Other Provider Identifiers
Issuer SPA
Number 0810284
State SC
Issuer COMMERCIAL
Number 168150600
State AL
Issuer MEDICAID
Number 529901280
State AL
Issuer RAILROAD MEDICARE
Number 180036556
Issuer COMMERCIAL
Number 5567071
State AL
Issuer BLUE CROSS
Number 000008486A
State AL
Issuer MEDICAID
Number 000008486
State AL
Issuer COMMERCIAL
Number 261210236
Issuer COMMERCIAL
Number 3125128
State AL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
TENNESSEE RIVER EYE CLINIC, P.C. 401K PROFIT SHARING PLAN 2023 631222875 2024-04-19 TENNESSEE RIVER EYE CLINIC, P.C. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 2563812020
Plan sponsor’s address 1110 S MONTGOMERY AVE, SHEFFIELD, AL, 356606330
TENNESSEE RIVER EYE CLINIC, P.C. 401K PROFIT SHARING PLAN 2022 631222875 2023-03-24 TENNESSEE RIVER EYE CLINIC, P.C. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 2563812020
Plan sponsor’s address 1110 S MONTGOMERY AVE, SHEFFIELD, AL, 356606330
TENNESSEE RIVER EYE CLINIC, P.C. 401K PROFIT SHARING PLAN 2021 631222875 2022-05-09 TENNESSEE RIVER EYE CLINIC, P.C. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 2563812020
Plan sponsor’s address 1110 S MONTGOMERY AVE, SHEFFIELD, AL, 356606330
TENNESSEE RIVER EYE CLINIC, P.C. 401K PROFIT SHARING PLAN 2020 631222875 2021-09-14 TENNESSEE RIVER EYE CLINIC, P.C. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 2563812020
Plan sponsor’s address 1110 S MONTGOMERY AVE, SHEFFIELD, AL, 356606330
TENNESSEE RIVER EYE CLINIC, P.C. 401K PROFIT SHARING PLAN 2019 631222875 2020-07-28 TENNESSEE RIVER EYE CLINIC, P.C. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 2563812020
Plan sponsor’s address 1110 S MONTGOMERY AVE, SHEFFIELD, AL, 356606330
TENNESSEE RIVER EYE CLINIC, P.C. 401K PROFIT SHARING PLAN 2018 631222875 2019-07-12 TENNESSEE RIVER EYE CLINIC, P.C. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 2563812020
Plan sponsor’s address 1110 S MONTGOMERY AVE, SHEFFIELD, AL, 356606330
TENNESSEE RIVER EYE CLINIC, P.C. 401K PROFIT SHARING PLAN 2017 631222875 2018-07-19 TENNESSEE RIVER EYE CLINIC, P.C. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 2563812020
Plan sponsor’s address 1110 S MONTGOMERY AVE, SHEFFIELD, AL, 356606330
TENNESSEE RIVER EYE CLINIC, P.C. 401K PROFIT SHARING PLAN 2016 631222875 2017-10-16 TENNESSEE RIVER EYE CLINIC, P.C. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 2563812020
Plan sponsor’s address 1111 SOUTH RALEIGH AVENUE, STE 900, SHEFFIELD, AL, 356606358
TENNESSEE RIVER EYE CLINIC, P.C. 401K PROFIT SHARING PLAN 2015 631222875 2016-07-28 TENNESSEE RIVER EYE CLINIC, P.C. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 2563812020
Plan sponsor’s address 1111 SOUTH RALEIGH AVENUE, STE 900, SHEFFIELD, AL, 356606358

Signature of
Role Plan administrator
Date 2016-07-28
Name of individual signing MARK A. KASSELS, M.D.
TENNESSEE RIVER EYE CLINIC, P.C. 401K PROFIT SHARING PLAN 2014 631222875 2015-05-20 TENNESSEE RIVER EYE CLINIC, P.C. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 2563812020
Plan sponsor’s address 1111 SOUTH RALEIGH AVENUE, STE 900, SHEFFIELD, AL, 356606358

Signature of
Role Plan administrator
Date 2015-05-20
Name of individual signing MARK A. KASSELS, M.D.

Agent

Name Role
KASSELLS, MARK Agent

Incorporator

Name Role
KASSELS, MARK Incorporator

Related by officers

No related officers

Related by address

SHEFFIELD, AL

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1111 S RALEIGH AVESHEFFIELD, AL 35660

Community Health Supply, Inc.

Date of last update: 01 Aug 2024

Sources: Alabama Secretary of State

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