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Dibyajiban Mahapatra, M.D., P.C.

Details

Name: Dibyajiban Mahapatra, M.D., P.C.
Jurisdiction: Alabama
Legal type: Domestic Professional Corporation
Status: Exists
Date of registration: 31 May 2002 (22 years ago)
Entity Number: 000-223-218
Register Number: 000223218
County: Madison
Place of Formation: Madison County
Principal Address: HUNTSVILLE, AL
Registered Office Street Address: 185 WHITESPORT DR STE 7HUNTSVILLE, AL 35801
Registered Office Street Address ZIP Code: 35801
Authorized Capital: $1,000

Activities PROVIDE MEDICAL SERVICES

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1548318645 2007-01-08 2008-09-09 16025 MICHELLE DRIVE, HUNTSVILLE, AL, 35803, US 185 WHITESPORTS DRIVE, SUITE NO. 7, HUNTSVILLE, AL, 35801, US

Contacts
Phone +1 256-883-6125
Fax 2568836432
Phone +1 256-883-6966

Authorized person
Name DR. DIBYAJIBAN MAHAPATRA
Role PHYSICIAN
Phone 2568836966

Taxonomy
Taxonomy Code 207R00000X - Internal Medicine Physician
License Number 20939
State AL
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 529911790
State AL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
DIBYAJIBAN MAHAPATRA, M.D., P.C. CASH BALANCE PLAN 2023 412036990 2024-10-02 DIBYAJIBAN MAHAPATRA, M.D., P.C. 4
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2021-01-01
Business code 621111
Sponsor’s telephone number 2568836966
Plan sponsor’s address 185 WHITESPORT DRIVE SW, STE 7, HUNTSVILLE, AL, 35801
DIBYAJIBAN MAHAPATRA MD 401(K) PROFIT SHARING PLAN 2023 412036990 2024-10-02 DIBYAJIBAN MAHAPATRA, M.D., P.C. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-01-01
Business code 621111
Sponsor’s telephone number 2568836966
Plan sponsor’s address 185 WHITESPORT DRIVE SW, STE 7, HUNTSVILLE, AL, 35801
DIBYAJIBAN MAHAPATRA, M.D., P.C. CASH BALANCE PLAN 2022 412036990 2023-10-05 DIBYAJIBAN MAHAPATRA, M.D., P.C. 3
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2021-01-01
Business code 621111
Sponsor’s telephone number 2568836966
Plan sponsor’s address 185 WHITESPORT DRIVE SW, STE 7, HUNTSVILLE, AL, 35801
DIBYAJIBAN MAHAPATRA MD 401(K) PROFIT SHARING PLAN 2022 412036990 2023-07-20 DIBYAJIBAN MAHAPATRA, M.D., P.C. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-01-01
Business code 621111
Sponsor’s telephone number 2568836966
Plan sponsor’s address 185 WHITESPORT DRIVE SW, STE 7, HUNTSVILLE, AL, 35801
DIBYAJIBAN MAHAPATRA MD 401(K) PROFIT SHARING PLAN 2021 412036990 2022-10-03 DIBYAJIBAN MAHAPATRA, M.D., P.C. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-01-01
Business code 621111
Sponsor’s telephone number 2568836966
Plan sponsor’s address 185 WHITESPORT DRIVE SW, STE 7, HUNTSVILLE, AL, 35801
DIBYAJIBAN MAHAPATRA MD 401(K) PROFIT SHARING PLAN 2020 412036990 2021-09-24 DIBYAJIBAN MAHAPATRA, M.D., P.C. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-01-01
Business code 621111
Sponsor’s telephone number 2568836966
Plan sponsor’s address 185 WHITESPORT DRIVE SW, STE 7, HUNTSVILLE, AL, 35801

Signature of
Role Plan administrator
Date 2021-09-24
Name of individual signing DIBYAJIBAN MAHAPATRA
DIBYAJIBAN MAHAPATRA MD 401(K) PROFIT SHARING PLAN 2019 412036990 2020-07-31 DIBYAJIBAN MAHAPATRA, M.D., P.C. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-01-01
Business code 621111
Sponsor’s telephone number 2568836966
Plan sponsor’s address 185 WHITESPORT DRIVE SW, STE 7, HUNTSVILLE, AL, 35801
DIBYAJIBAN MAHAPATRA MD 401(K) PROFIT SHARING PLAN 2018 412036990 2019-03-15 DIBYAJIBAN MAHAPATRA, M.D., P.C. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-01-01
Business code 621111
Sponsor’s telephone number 2568836966
Plan sponsor’s address 185 WHITESPORT DRIVE SW, STE 7, HUNTSVILLE, AL, 35801
DIBYAJIBAN MAHAPATRA MD 401(K) PROFIT SHARING PLAN 2017 412036990 2018-07-10 DIBYAJIBAN MAHAPATRA, M.D., P.C. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-01-01
Business code 621111
Sponsor’s telephone number 2568836966
Plan sponsor’s address 185 WHITESPORT DRIVE SW, STE 7, HUNTSVILLE, AL, 35801
DIBYAJIBAN MAHAPATRA MD 401(K) PROFIT SHARING PLAN 2016 412036990 2017-06-27 DIBYAJIBAN MAHAPATRA, M.D., P.C. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-01-01
Business code 621111
Sponsor’s telephone number 2568836966
Plan sponsor’s address 185 WHITESPORT DRIVE SW, STE 7, HUNTSVILLE, AL, 35801

Agent

Name Role
MAHAPATRA, DIBYAJIBAN Agent

Incorporator

Name Role
MAHAPATRA, DIBYAJIBAN Incorporator

Related by officers

MAHAPATRA, DIBYAJIBAN

South Huntsville Internal Medicine, P.C.

Related by address

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Date of last update: 02 Aug 2024

Sources: Alabama Secretary of State

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