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Gardendale Physician Associates, P.C.

Details

Name: Gardendale Physician Associates, P.C.
Jurisdiction: Alabama
Legal type: Domestic Professional Corporation
Status: Dissolved
Date of registration: 25 Jan 2005 (20 years ago)
Date of dissolution: 28 Dec 2016
Entity Number: 000-239-524
Register Number: 000239524
Historical Names: Gardendale Internal Medicine, P.C.
County: Jefferson
Place of Formation: Jefferson County
Registered Office Street Address: 2233 DECATUR HIGHWAY STE 102GARDENDALE, AL 35071
Registered Office Street Address ZIP Code: 35071
Authorized Capital: $1,000

Activities PRACTICE OF MEDICINE

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1558303842 2006-06-12 2020-08-22 2217 DECATUR HWY, SUITE 101, GARDENDALE, AL, 350712301, US 2217 DECATUR HWY, SUITE 101, GARDENDALE, AL, 350712301, US

Contacts
Phone +1 205-418-1212
Fax 2054181210

Authorized person
Name NOLAN LEONARD HUDSON
Role MANAGING MEMBER
Phone 2054181221

Taxonomy
Taxonomy Code 207R00000X - Internal Medicine Physician
License Number 6626
State AL
Is Primary No
Taxonomy Code 207R00000X - Internal Medicine Physician
License Number 12987
State AL
Is Primary No
Taxonomy Code 207R00000X - Internal Medicine Physician
License Number 21240
State AL
Is Primary No
Taxonomy Code 207R00000X - Internal Medicine Physician
License Number 7130
State AL
Is Primary No
Taxonomy Code 2085R0202X - Diagnostic Radiology Physician
License Number 17189
State AL
Is Primary No
Taxonomy Code 225100000X - Physical Therapist
License Number PTH3430
State AL
Is Primary No
Taxonomy Code 225100000X - Physical Therapist
License Number PTH4168
State AL
Is Primary No

Other Provider Identifiers
Issuer NPI# AMANDA C. HENDERSON,
Number 1336195494
State AL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
GARDENDALE PHYSICIAN ASSOCIATES, P.C. 401(K) PROFIT SHARING PLAN 2011 202222536 2012-10-10 GARDENDALE PHYSICIAN ASSOCIATES, P.C. 40
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 2058719940
Plan sponsor’s address 2217 DECATUR HIGHWAY, GARDENDALE, AL, 35071

Plan administrator’s name and address
Administrator’s EIN 202222536
Plan administrator’s name GARDENDALE PHYSICIAN ASSOCIATES, P.C.
Plan administrator’s address 2217 DECATUR HIGHWAY, GARDENDALE, AL, 35071
Administrator’s telephone number 2058719940

Signature of
Role Plan administrator
Date 2012-10-10
Name of individual signing NOLAN H HUDSON
GARDENDALE PHYSICIAN ASSOCIATES, P.C. 401(K) PROFIT SHARING PLAN 2011 202222536 2012-10-05 GARDENDALE PHYSICIAN ASSOCIATES, P.C. 46
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 2058719940
Plan sponsor’s address 2217 DECATUR HIGHWAY, GARDENDALE, AL, 35071

Plan administrator’s name and address
Administrator’s EIN 202222536
Plan administrator’s name GARDENDALE PHYSICIAN ASSOCIATES, P.C.
Plan administrator’s address 2217 DECATUR HIGHWAY, GARDENDALE, AL, 35071
Administrator’s telephone number 2058719940

Signature of
Role Plan administrator
Date 2012-10-05
Name of individual signing NOLAN H HUDSON
GARDENDALE PHYSICIAN ASSOCIATES, P.C. 401(K) PROFIT SHARING PLAN 2010 202222536 2011-10-14 GARDENDALE PHYSICIAN ASSOCIATES, P.C. 43
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 2058719940
Plan sponsor’s address 2217 DECATUR HIGHWAY, GARDENDALE, AL, 35071

Plan administrator’s name and address
Administrator’s EIN 202222536
Plan administrator’s name GARDENDALE PHYSICIAN ASSOCIATES, P.C.
Plan administrator’s address 2217 DECATUR HIGHWAY, GARDENDALE, AL, 35071
Administrator’s telephone number 2058719940

Signature of
Role Plan administrator
Date 2011-10-14
Name of individual signing NOLAN H HUDSON
GARDENDALE PHYSICIAN ASSOCIATES, P.C. 401(K) PROFIT SHARING PLAN 2009 202222536 2010-10-14 GARDENDALE PHYSICIAN ASSOCIATES, P.C. 38
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 2058719940
Plan sponsor’s address 2217 DECATUR HIGHWAY, GARDENDALE, AL, 35071

Plan administrator’s name and address
Administrator’s EIN 202222536
Plan administrator’s name GARDENDALE PHYSICIAN ASSOCIATES, P.C.
Plan administrator’s address 2217 DECATUR HIGHWAY, GARDENDALE, AL, 35071
Administrator’s telephone number 2058719940

Signature of
Role Plan administrator
Date 2010-10-13
Name of individual signing JENNIFER DEBRULER

Agent

Name Role
HUDSON, NOLAN Agent

Incorporator

Name Role Address
HUDSON, NOLAN Incorporator No data
HOWELL, WILLIAM Incorporator 2399 SOUTH BROAD STREETALBERTVILLE, AL 35950

Events

Event Date Event Type Old Value New Value
2005-08-04 Name Change Gardendale Internal Medicine, P.C. Gardendale Physician Associates, P.C.

Related by officers

HUDSON, NOLAN

Birmingham Medical Foundation, P.C. Healthcare Billing Solutions, LLC MNH, LLC Armaria Data Systems, LLC Gardendale Medical Clinic, LLC

HOWELL, WILLIAM

Dixie Grey, Inc. W.S. Howell Enterprises, Inc. MSAL TRANSPORTATION, INC. Phoenix Solutions, Inc.

Related by address

No related companies by address

Date of last update: 02 Aug 2024

Sources: Alabama Secretary of State

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