| Name: | Greystone Internal Medicine, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Dissolved |
| Date of registration: | 30 Oct 2001 (23 years ago) |
| Date of dissolution: | 21 Dec 2012 |
| Entity Number: | 000-219-707 |
| Register Number: | 000219707 |
| County: | Shelby |
| Place of Formation: | Shelby County |
| Principal Address: | BIRMINGHAM, AL |
| Registered Office Street Address: | 5420 HIGHWAY 280 STE 400BIRMINGHAM, AL 35242 |
| Registered Office Street Address ZIP Code: | 35242 |
| Authorized Capital: | $900 |
Activities
PRACTICE MEDICINE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1891804688 | 2006-08-29 | 2010-08-24 | PO BOX 383037, BIRMINGHAM, AL, 352383037, US | 101 MISSIONARY RDG, SUITE 200, BIRMINGHAM, AL, 352425255, US | |||||||||||||||||||||
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| Phone | +1 205-995-2260 |
| Fax | 2059800133 |
Authorized person
| Name | DR. KARIN B ROCK |
| Role | SECRETARY |
| Phone | 2059952260 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS |
| Number | I728 |
| State | AL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| GREYSTONE INTERNAL MEDICINE 401K PLAN | 2012 | 631285986 | 2014-10-15 | GREYSTONE INTERNAL MEDICINE, P.C. | 16 | |||||||||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2014-10-15 |
| Name of individual signing | DAVID B. WILHELM |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2002-08-16 |
| Business code | 621111 |
| Sponsor’s telephone number | 2059952260 |
| Plan sponsor’s address | 101 MISSIONARY RIDGE, SUITE 200, BIRMINGHAM, AL, 35242 |
Plan administrator’s name and address
| Administrator’s EIN | 631285986 |
| Plan administrator’s name | GREYSTONE INTERNAL MEDICINE, P.C. |
| Plan administrator’s address | 101 MISSIONARY RIDGE, SUITE 200, BIRMINGHAM, AL, 35242 |
| Administrator’s telephone number | 2059952260 |
Signature of
| Role | Plan administrator |
| Date | 2012-10-20 |
| Name of individual signing | DAVID B. WILHELM |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2002-08-16 |
| Business code | 621111 |
| Sponsor’s telephone number | 2059952260 |
| Plan sponsor’s address | 101 MISSIONARY RIDGE, SUITE 200, BIRMINGHAM, AL, 35242 |
Plan administrator’s name and address
| Administrator’s EIN | 631285986 |
| Plan administrator’s name | GREYSTONE INTERNAL MEDICINE, P.C. |
| Plan administrator’s address | 101 MISSIONARY RIDGE, SUITE 200, BIRMINGHAM, AL, 35242 |
| Administrator’s telephone number | 2059952260 |
Signature of
| Role | Plan administrator |
| Date | 2012-10-23 |
| Name of individual signing | DAVID B. WILHELM |
| Name | Role |
|---|---|
| WILHELM, DAVID B | Agent |
| Name | Role |
|---|---|
| WILHELM, DAVID B | Incorporator |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
