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Anesthesia Solutions of Mobile, Inc.

Details

Name: Anesthesia Solutions of Mobile, Inc.
Jurisdiction: Alabama
Legal type: Domestic Corporation
Status: Dissolved
Date of registration: 24 Jun 2002 (22 years ago) (Companies founded in June 2002)
Date of dissolution: 18 Nov 2015
Entity Number: 000-223-640
Register Number: 000223640
ZIP code: 36608 (Companies in Mobile, 36608)
County: Mobile
Place of Formation: Mobile County
Principal Address: MOBILE, AL
Registered Office Street Address: 6801 AIRPORT BLVDMOBILE, AL 36608
Authorized Capital: $40,000

Activities PROVIDE ANESTHESIA SERVICES

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1689617953 2006-06-14 2013-01-31 PO BOX 610, FREDERICK, MD, 217050610, US 6801 AIRPORT BLVD, ANESTHESIA DEPARTMENT, MOBILE, AL, 366083709, US

Contacts
Phone +1 866-607-8693
Fax 2405661680
Phone +1 251-631-3270
Fax 2516313273

Authorized person
Name MR. CLARK P. CHRISTIANSON
Role PRESIDENT
Phone 2516331660

Taxonomy
Taxonomy Code 207L00000X - Anesthesiology Physician
Is Primary Yes
Taxonomy Code 367500000X - Certified Registered Nurse Anesthetist
Is Primary No

Other Provider Identifiers
Issuer MEDICAID
Number 529912760
State AL
Issuer US DEPARTMENT OF LABOR
Number 362602200
Issuer MEDICAID
Number 01583765
State MS

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
ASM 401K RETIREMENT PLAN 2015 820547505 2016-02-16 ANESTHESIA SOLUTIONS OF MOBILE, INC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621399
Sponsor’s telephone number 2516393270
Plan sponsor’s address 6701 AIRPORT BLVD STE A101, MOBILE, AL, 366086767

Signature of
Role Plan administrator
Date 2016-02-16
Name of individual signing DAN WATSON
ASM 401K RETIREMENT PLAN 2014 820547505 2015-09-10 ANESTHESIA SOLUTIONS OF MOBILE, INC 37
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621399
Sponsor’s telephone number 2516393270
Plan sponsor’s address 6701 AIRPORT BLVD STE A101, MOBILE, AL, 366086767

Signature of
Role Plan administrator
Date 2015-09-10
Name of individual signing DAN WATSON
ASM 401K RETIREMENT PLAN 2013 820547505 2014-09-22 ANESTHESIA SOLUTIONS OF MOBILE, INC 35
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621399
Sponsor’s telephone number 2516393270
Plan sponsor’s address 6701 AIRPORT BLVD STE A101, MOBILE, AL, 366086767

Signature of
Role Plan administrator
Date 2014-09-22
Name of individual signing DAN WATSON
ASM 401K RETIREMENT PLAN 2012 820547505 2014-09-22 ANESTHESIA SOLUTIONS OF MOBILE, INC 36
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621399
Sponsor’s telephone number 2516393270
Plan sponsor’s address 6701 AIRPORT BLVD STE A101, MOBILE, AL, 366086767

Signature of
Role Plan administrator
Date 2014-09-22
Name of individual signing DAN WATSON
ASM 401K RETIREMENT PLAN 2012 820547505 2013-10-14 ANESTHESIA SOLUTIONS OF MOBILE, INC 36
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621399
Sponsor’s telephone number 2516393270
Plan sponsor’s address 6701 AIRPORT BLVD STE A101, MOBILE, AL, 366086767

Signature of
Role Plan administrator
Date 2013-10-13
Name of individual signing DAN WATSON
Role Employer/plan sponsor
Date 2013-10-13
Name of individual signing DAN WATSON
ASM 401K RETIREMENT PLAN 2011 820547505 2013-10-14 ANESTHESIA SOLUTIONS OF MOBILE, INC 40
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621399
Sponsor’s telephone number 2516393270
Plan sponsor’s address 6701 AIRPORT BLVD STE A101, MOBILE, AL, 366086767

Plan administrator’s name and address
Administrator’s EIN 820547505
Plan administrator’s name ANESTHESIA SOLUTIONS OF MOBILE, INC
Plan administrator’s address 6701 AIRPORT BLVD STE A101, MOBILE, AL, 366086767
Administrator’s telephone number 2516393270

Signature of
Role Plan administrator
Date 2013-10-13
Name of individual signing RAY D. WATSON
Role Employer/plan sponsor
Date 2013-10-13
Name of individual signing RAY D. WATSON
ASM 401K RETIREMENT PLAN 2011 820547505 2012-10-13 ANESTHESIA SOLUTIONS OF MOBILE, INC 40
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621399
Sponsor’s telephone number 2516393270
Plan sponsor’s address 6701 AIRPORT BLVD STE A101, MOBILE, AL, 366086767

Plan administrator’s name and address
Administrator’s EIN 820547505
Plan administrator’s name ANESTHESIA SOLUTIONS OF MOBILE, INC
Plan administrator’s address 6701 AIRPORT BLVD STE A101, MOBILE, AL, 366086767
Administrator’s telephone number 2516393270

Signature of
Role Plan administrator
Date 2012-10-12
Name of individual signing RAY D. WATSON
ASM 401K RETIREMENT PLAN 2010 820547505 2011-10-14 ANESTHESIA SOLUTIONS OF MOBILE, INC 41
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621399
Sponsor’s telephone number 2516393270
Plan sponsor’s address 6701 AIRPORT BLVD STE A101, MOBILE, AL, 366086767

Plan administrator’s name and address
Administrator’s EIN 820547505
Plan administrator’s name ANESTHESIA SOLUTIONS OF MOBILE, INC
Plan administrator’s address 6701 AIRPORT BLVD STE A101, MOBILE, AL, 366086767
Administrator’s telephone number 2516393270

Signature of
Role Plan administrator
Date 2011-10-14
Name of individual signing RAY D. WATSON
ASM 401K RETIREMENT PLAN 2009 820547505 2010-10-04 ANESTHESIA SOLUTIONS OF MOBILE, INC 39
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621399
Sponsor’s telephone number 2516393270
Plan sponsor’s address 6701 AIRPORT BLVD STE A101, MOBILE, AL, 366086767

Plan administrator’s name and address
Administrator’s EIN 820547505
Plan administrator’s name ANESTHESIA SOLUTIONS OF MOBILE, INC
Plan administrator’s address 6701 AIRPORT BLVD STE A101, MOBILE, AL, 366086767
Administrator’s telephone number 2516393270

Signature of
Role Plan administrator
Date 2010-10-04
Name of individual signing RAY D WATSON
ASM 401K RETIREMENT PLAN 2009 820547505 2011-10-05 ANESTHESIA SOLUTIONS OF MOBILE, INC 39
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621399
Sponsor’s telephone number 2516393270
Plan sponsor’s address 6701 AIRPORT BLVD STE A101, MOBILE, AL, 366086767

Plan administrator’s name and address
Administrator’s EIN 820547505
Plan administrator’s name ANESTHESIA SOLUTIONS OF MOBILE, INC
Plan administrator’s address 6701 AIRPORT BLVD STE A101, MOBILE, AL, 366086767
Administrator’s telephone number 2516393270

Signature of
Role Plan administrator
Date 2011-10-05
Name of individual signing RAY D WATSON

Agent

Name Role Address
CHRISTIANSON, CLARK Agent 600 AZALEA ROADMOBILE, AL 36609

Incorporator

Name Role
VINCENT, RICHARD Incorporator

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CHRISTIANSON, CLARK

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VINCENT, RICHARD

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Related by address

MOBILE, AL

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6801 AIRPORT BLVDMOBILE, AL 36608

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Date of last update: 02 Aug 2024

Sources: Alabama Secretary of State

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