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Bay Urology Services, P.C.

Details

Name: Bay Urology Services, P.C.
Jurisdiction: Alabama
Legal type: Domestic Professional Corporation
Status: Dissolved
Date of registration: 17 Feb 2005 (20 years ago)
Date of dissolution: 18 Aug 2020
Entity Number: 000-239-822
Register Number: 000239822
County: Mobile
Place of Formation: Mobile County
Principal Address: MOBILE, AL
Registered Office Street Address: 6701 AIRPORT BLVD STE B 111MOBILE, AL 36608
Registered Office Street Address ZIP Code: 36608
Authorized Capital: $1,000

Activities PRACTICE OF MEDICINE

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1275773970 2009-02-20 2009-02-20 6701 AIRPORT BLVD, SUITE B111, MOBILE, AL, 366086705, US 6701 AIRPORT BLVD, SUITE B111, MOBILE, AL, 366086705, US

Contacts
Phone +1 251-633-3617

Authorized person
Name MRS. RITA WEBB
Role INS
Phone 2516333617

Taxonomy
Taxonomy Code 174400000X - Specialist
License Number 7939
State AL
Is Primary Yes
Taxonomy Code 174400000X - Specialist
License Number 13909
State AL
Is Primary No
Taxonomy Code 174400000X - Specialist
License Number 00022814
State AL
Is Primary No

Other Provider Identifiers
Issuer BCBS AL
Number 51595624
State AL
Issuer BCBS AL
Number 51595626
State AL
Issuer BCBS AL
Number 51595623
State AL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
BAY UROLOGY SERVICES, P. C. 2019 202371174 2020-12-03 BAY UROLOGY SERVICES, P.C. 19
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-07-05
Business code 621111
Sponsor’s telephone number 2513783000
Plan sponsor’s address 6701 AIRPORT BLVD. SUITE B-111, MOBILE, AL, 36608
BAY UROLOGY SERVICES, P.C. 401(K) PLAN 2019 202371174 2020-02-06 BAY UROLOGY SERVICES, P.C. 19
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-07-01
Business code 621111
Sponsor’s telephone number 2513783000
Plan sponsor’s address 6701 AIRPORT BLVD. SUITE B-111, MOBILE, AL, 36608
BAY UROLOGY SERVICES, P.C. 401(K) PLAN 2018 202371174 2019-02-14 BAY UROLOGY SERVICES, P.C. 19
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-07-01
Business code 621111
Sponsor’s telephone number 2513783000
Plan sponsor’s address 6701 AIRPORT BLVD. SUITE B-111, MOBILE, AL, 36608

Signature of
Role Plan administrator
Date 2019-02-14
Name of individual signing WILLIAM E BLAYLOCK
Role Employer/plan sponsor
Date 2019-02-14
Name of individual signing WILLIAM E. BLAYLOCK
BAY UROLOGY SERVICES, P.C. 401(K) PLAN 2017 202371174 2018-03-29 BAY UROLOGY SERVICES, P.C. 17
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-07-01
Business code 621111
Sponsor’s telephone number 2513783000
Plan sponsor’s address 6701 AIRPORT BLVD. SUITE B-111, MOBILE, AL, 36608

Signature of
Role Plan administrator
Date 2018-03-29
Name of individual signing WILLIAM E BLAYLOCK
Role Employer/plan sponsor
Date 2018-03-29
Name of individual signing WILLIAM E. BLAYLOCK
BAY UROLOGY SERVICES, P.C. 401(K) PLAN 2016 202371174 2017-05-17 BAY UROLOGY SERVICES, P.C. 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-07-01
Business code 621111
Sponsor’s telephone number 2513783000
Plan sponsor’s address 6701 AIRPORT BLVD. SUITE B-111, MOBILE, AL, 36608

Signature of
Role Plan administrator
Date 2017-05-16
Name of individual signing WILLIAM E BLAYLOCK
Role Employer/plan sponsor
Date 2017-05-16
Name of individual signing WILLIAM E. BLAYLOCK
BAY UROLOGY SERVICES, P.C. 401(K) PLAN 2015 202371174 2016-02-26 BAY UROLOGY SERVICES, P.C. 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-07-01
Business code 621111
Sponsor’s telephone number 2513783000
Plan sponsor’s address 6701 AIRPORT BLVD. SUITE B-111, MOBILE, AL, 36608

Signature of
Role Plan administrator
Date 2016-02-26
Name of individual signing WILLIAM E BLAYLOCK
Role Employer/plan sponsor
Date 2016-02-26
Name of individual signing WILLIAM E. BLAYLOCK
BAY UROLOGY SERVICES, P.C. 401(K) PLAN 2014 202371174 2015-04-22 BAY UROLOGY SERVICES, P.C. 18
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-07-01
Business code 621111
Sponsor’s telephone number 2513783000
Plan sponsor’s address 6701 AIRPORT BLVD. SUITE B-111, MOBILE, AL, 36608

Signature of
Role Plan administrator
Date 2015-04-06
Name of individual signing WILLIAM E BLAYLOCK
Role Employer/plan sponsor
Date 2015-04-22
Name of individual signing WILLIAM E BLAYLOCK
BAY UROLOGY SERVICES, P.C. 401(K) PLAN 2013 202371174 2014-04-17 BAY UROLOGY SERVICES, P.C. 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-07-01
Business code 621111
Sponsor’s telephone number 2513783000
Plan sponsor’s address 6701 AIRPORT BLVD. SUITE B-111, MOBILE, AL, 36608

Signature of
Role Plan administrator
Date 2014-04-16
Name of individual signing WILLIAM E BLAYLOCK
BAY UROLOGY SERVICES, P.C. 401(K) PLAN 2012 202371174 2013-04-25 BAY UROLOGY SERVICES, P.C. 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-07-01
Business code 621111
Sponsor’s telephone number 2513783000
Plan sponsor’s address 6701 AIRPORT BLVD. SUITE B-111, MOBILE, AL, 36608

Signature of
Role Plan administrator
Date 2013-04-25
Name of individual signing WILLIAM E BLAYLOCK
BAY UROLOGY SERVICES, P.C. 401(K) PLAN 2011 202371174 2012-03-01 BAY UROLOGY SERVICES, P.C. 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-07-01
Business code 621111
Sponsor’s telephone number 2513783000
Plan sponsor’s address 6701 AIRPORT BLVD. SUITE B-111, MOBILE, AL, 36608

Plan administrator’s name and address
Administrator’s EIN 202371174
Plan administrator’s name BAY UROLOGY SERVICES, P.C.
Plan administrator’s address 6701 AIRPORT BLVD. SUITE B-111, MOBILE, AL, 36608
Administrator’s telephone number 2513783000

Signature of
Role Plan administrator
Date 2012-03-01
Name of individual signing WILLIAM E BLAYLOCK

Agent

Name Role
COLEMAN, THOMAS W Agent

Incorporator

Name Role
BLAYLOCK, WILLIAM E Incorporator
COLEMAN, THOMAS W Incorporator

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COLEMAN, THOMAS W

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BLAYLOCK, WILLIAM E

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6701 AIRPORT BLVD STE B 111MOBILE, AL 36608

Internal Medicine Associates, P.A.

Date of last update: 02 Aug 2024

Sources: Alabama Secretary of State

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