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Creekside Family Practice, P.C.

Details

Name: Creekside Family Practice, P.C.
Jurisdiction: Alabama
Legal type: Domestic Professional Corporation
Status: Exists
Date of registration: 20 Feb 2004 (21 years ago)
Entity Number: 000-233-773
Register Number: 000233773
County: Madison
Place of Formation: Madison County
Principal Address: HUNTSVILLE, AL
Registered Office Street Address: 810 FRANKLIN ST SEHUNTSVILLE, AL 35801
Registered Office Street Address ZIP Code: 35801
Authorized Capital: $1,000

Activities MEDICAL PRACTICE

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1801097597 2007-05-30 2007-07-12 810 FRANKLIN ST SE, HUNTSVILLE, AL, 358014310, US 810 FRANKLIN ST SE, HUNTSVILLE, AL, 358014310, US

Contacts
Phone +1 256-551-6503
Fax 2565338935

Authorized person
Name DR. CLAUDE L KINZER
Role PRESIDENT
Phone 2565516503

Taxonomy
Taxonomy Code 207Q00000X - Family Medicine Physician
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
CREEKSIDE FAMILY PRACTICE PC 401(K) PLAN 2023 200724238 2024-06-13 CREEKSIDE FAMILY PRACTICE P.C. 39
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-04-13
Business code 621111
Sponsor’s telephone number 2565516503
Plan sponsor’s address 810 FRANKLIN ST, HUNTSVILLE, AL, 35801

Signature of
Role Plan administrator
Date 2024-06-13
Name of individual signing MICHAEL HONEYWELL
CREEKSIDE FAMILY PRACTICE PC 401(K) PLAN 2022 200724238 2023-07-14 CREEKSIDE FAMILY PRACTICE P.C. 34
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-04-13
Business code 621111
Sponsor’s telephone number 2565516503
Plan sponsor’s address 810 FRANKLIN ST, HUNTSVILLE, AL, 35801

Signature of
Role Plan administrator
Date 2023-07-14
Name of individual signing MICHAEL HONEYWELL
CREEKSIDE FAMILY PRACTICE PC 401(K) PLAN 2021 200724238 2022-07-14 CREEKSIDE FAMILY PRACTICE P.C. 33
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-04-13
Business code 621111
Sponsor’s telephone number 2565516503
Plan sponsor’s address 810 FRANKLIN ST, HUNTSVILLE, AL, 35801

Signature of
Role Plan administrator
Date 2022-07-14
Name of individual signing MICHAEL HONEYWELL
CREEKSIDE FAMILY PRACTICE PC 401(K) PLAN 2020 200724238 2021-05-18 CREEKSIDE FAMILY PRACTICE P.C. 37
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-04-13
Business code 621111
Sponsor’s telephone number 2565516503
Plan sponsor’s address 810 FRANKLIN ST, HUNTSVILLE, AL, 35801

Signature of
Role Plan administrator
Date 2021-05-18
Name of individual signing MICHAEL HONEYWELL
Role Employer/plan sponsor
Date 2021-05-18
Name of individual signing CHERYL ARY
CREEKSIDE FAMILY PRACTICE PC 401(K) PLAN 2019 200724238 2020-06-24 CREEKSIDE FAMILY PRACTICE P.C. 35
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-04-13
Business code 621111
Sponsor’s telephone number 2565516503
Plan sponsor’s address 810 FRANKLIN ST, HUNTSVILLE, AL, 35801

Signature of
Role Plan administrator
Date 2020-06-24
Name of individual signing MICHAEL HONEYWELL
Role Employer/plan sponsor
Date 2020-06-24
Name of individual signing CHERYL ARY
CREEKSIDE FAMILY PRACTICE PC 401(K) PLAN 2018 200724238 2019-07-02 CREEKSIDE FAMILY PRACTICE P.C. 36
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-04-13
Business code 621111
Sponsor’s telephone number 2565516503
Plan sponsor’s address 810 FRANKLIN ST, HUNTSVILLE, AL, 35801

Signature of
Role Plan administrator
Date 2019-07-02
Name of individual signing CLAUDE L KINZER
Role Employer/plan sponsor
Date 2019-06-20
Name of individual signing CHERYL ARY
CREEKSIDE FAMILY PRACTICE PC 401(K) PLAN 2017 200724238 2018-06-29 CREEKSIDE FAMILY PRACTICE P.C. 36
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-04-13
Business code 621111
Sponsor’s telephone number 2565516503
Plan sponsor’s address 810 FRANKLIN ST, HUNTSVILLE, AL, 35801

Signature of
Role Plan administrator
Date 2018-06-29
Name of individual signing CLAUDE L KINZER
Role Employer/plan sponsor
Date 2018-06-22
Name of individual signing CHERYL ARY
CREEKSIDE FAMILY PRACTICE PC 401(K) PLAN 2016 200724238 2017-06-27 CREEKSIDE FAMILY PRACTICE P.C. 33
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-04-13
Business code 621111
Sponsor’s telephone number 2565516503
Plan sponsor’s address 810 FRANKLIN ST, HUNTSVILLE, AL, 35801

Signature of
Role Plan administrator
Date 2017-06-26
Name of individual signing CLAUDE L KINZER
Role Employer/plan sponsor
Date 2017-06-27
Name of individual signing CHERYL ARY
CREEKSIDE FAMILY PRACTICE PC 401(K) PLAN 2015 200724238 2016-07-21 CREEKSIDE FAMILY PRACTICE P.C. 33
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-04-13
Business code 621111
Sponsor’s telephone number 2565516503
Plan sponsor’s address 810 FRANKLIN ST, HUNTSVILLE, AL, 35801

Agent

Name Role
HONEYWELL, MICHAEL H. Agent

Incorporator

Name Role Address
KINZER, CLAUDE L Incorporator 810 FRANKLIN STREETHUNTSVILLE, AL 35801

Related by officers

KINZER, CLAUDE L

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HUNTSVILLE, AL

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810 FRANKLIN ST SEHUNTSVILLE, AL 35801

HRCCFP, LLC

Date of last update: 02 Aug 2024

Sources: Alabama Secretary of State

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