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Appalachian Cardiovascular Associates, Inc.

Details

Name: Appalachian Cardiovascular Associates, Inc.
Jurisdiction: Alabama
Legal type: Domestic Corporation
Status: Dissolved
Date of registration: 14 Aug 2002 (22 years ago) (Companies founded in August 2002)
Date of dissolution: 25 Apr 2022
Entity Number: 000-224-563
Register Number: 000224563
ZIP code: 35968 (Companies in De Kalb, 35968)
County: De Kalb
Place of Formation: DeKalb County
Principal Address: FORT PAYNE, AL
Registered Office Street Address: 2804 GREENHILL BLVD NW STE 101FORT PAYNE, AL 35968
Authorized Capital: $1,000

Activities PROVIDE MEDICAL SERVICES

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1508993668 2007-02-27 2011-10-24 PO BOX 681239, FORT PAYNE, AL, 359681613, US 1990 GAULT AVE N, SUITE 200, FORT PAYNE, AL, 359673418, US

Contacts
Phone +1 256-997-9200
Fax 2569970002

Authorized person
Name DR. SANJEEV SAXENA
Role OWNER
Phone 2569979200

Taxonomy
Taxonomy Code 207RI0011X - Interventional Cardiology Physician
License Number 24558
State AL
Is Primary Yes

Other Provider Identifiers
Issuer BCBS OF ALABAMA
Number 51511919
State AL
Issuer MEDICARE RAILROAD
Number 060069630
State AL
Issuer MEDICAID
Number 051551802
State AL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
APPALACHIAN CARDIOVASCULAR ASSOCIATES, INC. RETIREMENT PLAN 2015 431770500 2016-03-28 APPALACHIAN CARDIOVASCULAR ASSOCIATES, INC. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 2569979200
Plan sponsor’s address P.O. BOX 681239, FORT PAYNE, AL, 359681613

Plan administrator’s name and address
Administrator’s EIN 431770500
Plan administrator’s name APPALACHIAN CARDIOVASCULAR ASSOCIATES, INC.
Plan administrator’s address P.O. BOX 681239, FORT PAYNE, AL, 359681613
Administrator’s telephone number 2569979200
APPALACHIAN CARDIOVASCULAR ASSOCIATES, INC. RETIREMENT PLAN 2014 431770500 2015-07-30 APPALACHIAN CARDIOVASCULAR ASSOCIATES, INC. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 2569979200
Plan sponsor’s address P.O. BOX 681239, FORT PAYNE, AL, 359681613

Plan administrator’s name and address
Administrator’s EIN 431770500
Plan administrator’s name APPALACHIAN CARDIOVASCULAR ASSOCIATES, INC.
Plan administrator’s address P.O. BOX 681239, FORT PAYNE, AL, 359681613
Administrator’s telephone number 2569979200

Signature of
Role Plan administrator
Date 2015-07-30
Name of individual signing SANJEEV SAXENA, M.D.
APPALACHIAN CARDIOVASCULAR ASSOCIATES, INC. RETIREMENT PLAN 2013 431770500 2014-07-30 APPALACHIAN CARDIOVASCULAR ASSOCIATES, INC. 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 2569979200
Plan sponsor’s address P.O. BOX 681239, FORT PAYNE, AL, 359681613

Plan administrator’s name and address
Administrator’s EIN 431770500
Plan administrator’s name APPALACHIAN CARDIOVASCULAR ASSOCIATES, INC.
Plan administrator’s address P.O. BOX 681239, FORT PAYNE, AL, 359681613
Administrator’s telephone number 2569979200

Signature of
Role Plan administrator
Date 2014-07-30
Name of individual signing SANJEEV SAXENA, M.D.
APPALACHIAN CARDIOVASCULAR ASSOCIATES, INC. RETIREMENT PLAN 2012 431770500 2013-07-22 APPALACHIAN CARDIOVASCULAR ASSOCIATES, INC. 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 2569979200
Plan sponsor’s address P.O. BOX 681239, FORT PAYNE, AL, 359681613

Plan administrator’s name and address
Administrator’s EIN 431770500
Plan administrator’s name APPALACHIAN CARDIOVASCULAR ASSOCIATES, INC.
Plan administrator’s address P.O. BOX 681239, FORT PAYNE, AL, 359681613
Administrator’s telephone number 2569979200

Signature of
Role Plan administrator
Date 2013-07-22
Name of individual signing SANJEEV SAXENA, M.D.
APPALACHIAN CARDIOVASCULAR ASSOCIATES, INC. RETIREMENT PLAN 2011 431770500 2012-08-03 APPALACHIAN CARDIOVASCULAR ASSOCIATES, INC. 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 2569979200
Plan sponsor’s address P.O. BOX 681239, FORT PAYNE, AL, 359681613

Plan administrator’s name and address
Administrator’s EIN 431770500
Plan administrator’s name APPALACHIAN CARDIOVASCULAR ASSOCIATES, INC.
Plan administrator’s address P.O. BOX 681239, FORT PAYNE, AL, 359681613
Administrator’s telephone number 2569979200

Signature of
Role Plan administrator
Date 2012-08-03
Name of individual signing SANJEEV SAXENA, M.D.
APPALACHIAN CARDIOVASCULAR ASSOCIATES, INC. RETIREMENT PLAN 2010 431770500 2011-07-26 APPALACHIAN CARDIOVASCULAR ASSOCIATES, INC. 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 2569979200
Plan sponsor’s address P.O. BOX 681239, FORT PAYNE, AL, 359681613

Plan administrator’s name and address
Administrator’s EIN 431770500
Plan administrator’s name APPALACHIAN CARDIOVASCULAR ASSOCIATES, INC.
Plan administrator’s address P.O. BOX 681239, FORT PAYNE, AL, 359681613
Administrator’s telephone number 2569979200

Signature of
Role Plan administrator
Date 2011-07-26
Name of individual signing SANJEEV SAXENA, M.D.
APPALACHIAN CARDIOVASCULAR ASSOCIATES, INC. RETIREMENT PLAN 2009 431770500 2010-09-25 APPALACHIAN CARDIOVASCULAR ASSOCIATES, INC. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 2569979200
Plan sponsor’s address P.O. BOX 681239, FORT PAYNE, AL, 359681613

Plan administrator’s name and address
Administrator’s EIN 431770500
Plan administrator’s name APPALACHIAN CARDIOVASCULAR ASSOCIATES, INC.
Plan administrator’s address P.O. BOX 681239, FORT PAYNE, AL, 359681613
Administrator’s telephone number 2569979200

Signature of
Role Plan administrator
Date 2010-09-25
Name of individual signing SANJEEV SAXENA, M.D.

Incorporator

Name Role Address
SAXENA, SANJEEV Incorporator 1990 GAULT AVE N STE 200FORT PAYNE, AL 35968

Agent

Name Role Address
SAXENA, SANJEEV Agent 1990 GAULT AVE N STE 200FORT PAYNE, AL 35968

Related by officers

SAXENA, SANJEEV

Timber Ridge, Inc. Fort Payne General Medicine, Inc. Aqua MediSpa and Vein Studio LLC Appalachian Research Associates LLC WOAT Auburn LLC WOAT Tuscaloosa LLC WOAT Boaz LLC WOAT Jacksonville LLC Appalachian Personnel Associates LLC VANGUARD FITNESS, INC.

Related by address

FORT PAYNE, AL

Pioneer Credit Company Dixie Express, Inc. DeSoto Country Club, Inc. The Fort Payne Athletic Assoc. Hi-Jac Corporation Horton Auto Parts, Incorporated Kirby Enterprises, Inc. L. D. McReynolds, Inc,. Ala-Tenn Valley Cotton Co., Inc. Mountain View Memory Gardens & Mausoleum, Inc.

Date of last update: 02 Aug 2024

Sources: Alabama Secretary of State

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