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South Baldwin Podiatry, P.C.

Details

Name: South Baldwin Podiatry, P.C.
Jurisdiction: Alabama
Legal type: Domestic Professional Corporation
Status: Exists
Date of registration: 19 Apr 2001 (24 years ago) (Companies founded in April 2001)
Entity Number: 000-216-210
Register Number: 000216210
ZIP code: 36536 (Companies in Baldwin, 36536)
County: Baldwin
Place of Formation: Baldwin County
Principal Address: FOLEY, AL
Registered Office Street Address: 112 WEST LAUREL AVEFOLEY, AL 36536
Authorized Capital: $2,000

Activities PRACTICE PODIATRY MEDICINE

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1922043140 2006-06-19 2013-08-23 1770 N ALSTON ST, FOLEY, AL, 365352274, US 1770 N ALSTON ST, FOLEY, AL, 365352274, US

Contacts
Phone +1 251-943-3668
Fax 2519433314

Authorized person
Name KERI KRAFT
Role OFFICE MANAGER
Phone 2519433668

Taxonomy
Taxonomy Code 213E00000X - Podiatrist
License Number 244
State AL
Is Primary Yes
Taxonomy Code 332B00000X - Durable Medical Equipment & Medical Supplies
Is Primary No

Other Provider Identifiers
Issuer MEDICAID
Number 529908470
State AL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
SOUTH BALDWIN PODIATRY 401(K) PLAN 2023 631273583 2024-07-24 SOUTH BALDWIN PODIATRY 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621111
Sponsor’s telephone number 2519433668
Plan sponsor’s address 1770 NORTH ALSTON STREET, FOLEY, AL, 36535
SOUTH BALDWIN PODIATRY 401(K) PLAN 2022 631273583 2023-08-07 SOUTH BALDWIN PODIATRY 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621111
Sponsor’s telephone number 2519433668
Plan sponsor’s address 1770 NORTH ALSTON STREET, FOLEY, AL, 36535
SOUTH BALDWIN PODIATRY 401(K) PLAN 2022 631273583 2023-08-07 SOUTH BALDWIN PODIATRY 6
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621111
Sponsor’s telephone number 2519433668
Plan sponsor’s address 1770 NORTH ALSTON STREET, FOLEY, AL, 36535
SOUTH BALDWIN PODIATRY 401(K) PLAN 2021 631273583 2022-07-11 SOUTH BALDWIN PODIATRY 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621111
Sponsor’s telephone number 2519433668
Plan sponsor’s address 1770 NORTH ALSTON STREET, FOLEY, AL, 36535
SOUTH BALDWIN PODIATRY 401(K) PLAN 2020 631273583 2021-07-28 SOUTH BALDWIN PODIATRY 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621111
Sponsor’s telephone number 2519433668
Plan sponsor’s address 1770 NORTH ALSTON STREET, FOLEY, AL, 36535
SOUTH BALDWIN PODIATRY 401(K) PLAN 2019 631273583 2020-03-10 SOUTH BALDWIN PODIATRY 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621111
Sponsor’s telephone number 2519433668
Plan sponsor’s address 1770 NORTH ALSTON STREET, FOLEY, AL, 36535
SOUTH BALDWIN PODIATRY 401(K) PLAN 2018 631273583 2019-07-01 SOUTH BALDWIN PODIATRY 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621111
Sponsor’s telephone number 2519433668
Plan sponsor’s address 1770 NORTH ALSTON STREET, FOLEY, AL, 36535
SOUTH BALDWIN PODIATRY 401(K) PLAN 2017 631273583 2018-09-12 SOUTH BALDWIN PODIATRY 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621111
Sponsor’s telephone number 2519433668
Plan sponsor’s address 1770 NORTH ALSTON STREET, FOLEY, AL, 36535

Signature of
Role Plan administrator
Date 2018-09-12
Name of individual signing DEBRA GIBSON
SOUTH BALDWIN PODIATRY 401(K) PLAN 2016 631273583 2017-02-15 SOUTH BALDWIN PODIATRY 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621111
Sponsor’s telephone number 2519433668
Plan sponsor’s address 1770 NORTH ALSTON STREET, FOLEY, AL, 36535

Signature of
Role Plan administrator
Date 2017-02-15
Name of individual signing DEBRA GIBSON
SOUTH BALDWIN PODIATRY 401(K) PLAN 2015 631273583 2016-09-06 SOUTH BALDWIN PODIATRY 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621111
Sponsor’s telephone number 2519433668
Plan sponsor’s address 1770 NORTH ALSTON STREET, FOLEY, AL, 36535

Signature of
Role Plan administrator
Date 2016-09-06
Name of individual signing DEBRA GIBSON

Agent

Name Role
GIBSON, DEBRA M Agent

Incorporator

Name Role Address
LEATHERBURY, GREGORY L JR Incorporator 71 NORTH SECTION STREET SUITE BFAIRHOPE, AL 36552

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112 WEST LAUREL AVEFOLEY, AL 36536

Coastal Transportation, LLC

Date of last update: 01 Aug 2024

Sources: Alabama Secretary of State

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