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SouthEastern Spine Specialists, Inc.

Details

Name: SouthEastern Spine Specialists, Inc.
Jurisdiction: Alabama
Legal type: Domestic Corporation
Status: Exists
Date of registration: 22 Mar 2005 (20 years ago)
Entity Number: 000-240-522
Register Number: 000240522
County: Tuscaloosa
Place of Formation: Tuscaloosa County
Principal Address: TUSCALOOSA, AL
Registered Office Street Address: 100 TOWNCENTER BLVD STE 113TUSCALOOSA, AL 35406
Registered Office Street Address ZIP Code: 35406
Authorized Capital: $5,000
Paid Share Capital: $1,000

Activities RENDER PROFESSIONAL MEDICAL SERVICES

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1356325138 2005-12-05 2009-07-27 1781 COMMONS NORTH LOOP, TUSCALOOSA, AL, 354063577, US 1781 COMMONS NORTH LOOP, TUSCALOOSA, AL, 354063577, US

Contacts
Phone +1 205-750-0447
Fax 2057500276

Authorized person
Name TIMOTHY DAVID BASSETT
Role PRESIDENT
Phone 2057500447

Taxonomy
Taxonomy Code 207XS0117X - Orthopaedic Surgery of the Spine Physician
License Number 00018074
State AL
Is Primary Yes

Other Provider Identifiers
Issuer BC/BS
Number 51527770
State SC
Issuer MEDICAID
Number 051527770
State AL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
SOUTHEASTERN SPINE SPECIALISTS, INC. 401(K) PLAN 2023 300302891 2024-07-12 SOUTHEASTERN SPINE SPECIALISTS, INC. 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 2057508457
Plan sponsor’s address 1781 COMMONS NORTH LOOP, TUSCALOOSA, AL, 354063577
SOUTHEASTERN SPINE SPECIALISTS, INC. CASH BALANCE PLAN 2022 300302891 2023-10-03 SOUTHEASTERN SPINE SPECIALISTS, INC. 7
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2019-01-01
Business code 621111
Sponsor’s telephone number 2057508457
Plan sponsor’s address 1781 COMMONS NORTH LOOP, TUSCALOOSA, AL, 354063577
SOUTHEASTERN SPINE SPECIALISTS, INC. 401(K) PLAN 2022 300302891 2023-06-08 SOUTHEASTERN SPINE SPECIALISTS, INC. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 2057508457
Plan sponsor’s address 1781 COMMONS NORTH LOOP, TUSCALOOSA, AL, 354063577
SOUTHEASTERN SPINE SPECIALISTS, INC. 401(K) PLAN 2021 300302891 2022-10-07 SOUTHEASTERN SPINE SPECIALISTS, INC. 9
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 2057500447
Plan sponsor’s address 1781 COMMONS NORTH LOOP, TUSCALOOSA, AL, 354063577

Signature of
Role Plan administrator
Date 2022-10-07
Name of individual signing TIMOTHY BASSETT
SOUTHEASTERN SPINE SPECIALISTS, INC. CASH BALANCE PLAN 2021 300302891 2022-10-17 SOUTHEASTERN SPINE SPECIALISTS, INC. 5
Three-digit plan number (PN) 002
Effective date of plan 2019-01-01
Business code 621111
Sponsor’s telephone number 2057508457
Plan sponsor’s address 1781 COMMONS NORTH LOOP, TUSCALOOSA, AL, 354063577

Signature of
Role Plan administrator
Date 2022-10-17
Name of individual signing TIMOTHY BASSETT
SOUTHEASTERN SPINE SPECIALISTS, INC. 401(K) PLAN 2021 300302891 2022-10-12 SOUTHEASTERN SPINE SPECIALISTS, INC. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 2057508457
Plan sponsor’s address 1781 COMMONS NORTH LOOP, TUSCALOOSA, AL, 354063577

Signature of
Role Plan administrator
Date 2022-10-12
Name of individual signing TIMOTHY BASSETT
SOUTHEASTERN SPINE SPECIALISTS, INC. CASH BALANCE PLAN 2021 300302891 2022-11-02 SOUTHEASTERN SPINE SPECIALISTS, INC. 5
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2019-01-01
Business code 621111
Sponsor’s telephone number 2057508457
Plan sponsor’s address 1781 COMMONS NORTH LOOP, TUSCALOOSA, AL, 354063577

Signature of
Role Plan administrator
Date 2022-11-02
Name of individual signing TIMOTHY BASSETT
SOUTHEASTERN SPINE SPECIALISTS, INC. CASH BALANCE PLAN 2020 300302891 2021-10-14 SOUTHEASTERN SPINE SPECIALISTS, INC. 4
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2019-01-01
Business code 621111
Sponsor’s telephone number 2057508457
Plan sponsor’s address 1781 COMMONS NORTH LOOP, TUSCALOOSA, AL, 354063577

Signature of
Role Plan administrator
Date 2021-10-14
Name of individual signing TIMOTHY BASSETT
SOUTHEASTERN SPINE SPECIALISTS, INC. 401(K) PLAN 2020 300302891 2021-09-21 SOUTHEASTERN SPINE SPECIALISTS, INC. 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 2057508457
Plan sponsor’s address 1781 COMMONS NORTH LOOP, TUSCALOOSA, AL, 354063577

Signature of
Role Plan administrator
Date 2021-09-21
Name of individual signing TIMOTHY BASSETT
SOUTHEASTERN SPINE SPECIALISTS, INC. CASH BALANCE PLAN 2019 300302891 2020-10-05 SOUTHEASTERN SPINE SPECIALISTS, INC. 4
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2019-01-01
Business code 621111
Sponsor’s telephone number 2057508457
Plan sponsor’s address 1781 COMMONS NORTH LOOP, TUSCALOOSA, AL, 354063577

Signature of
Role Plan administrator
Date 2020-10-05
Name of individual signing TIMOTHY BASSETT

Agent

Name Role Address
BASSETT, TIMOTHY Agent 13439 NORTH RIVER FARM DRIVENORTHPORT, AL 35473

Incorporator

Name Role Address
BASSETT, TIMOTHY Incorporator 13439 NORTH RIVER FARM DRIVENORTHPORT, AL 35473

Related by officers

BASSETT, TIMOTHY

Martin Road Properties, LLC Tuscaloosa South, L.L.C. Rice Colony Investments, L.L.C. Tuscaloosa's Local Channel, L.L.C. A. F. Financing Group, L.L.C. P.D.G., L.L.C. Tuscaloosa North, L.L.C.

Related by address

TUSCALOOSA, AL

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Date of last update: 02 Aug 2024

Sources: Alabama Secretary of State

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