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Colon & Rectal Surgical Associates of Birmingham, P.C.

Details

Name: Colon & Rectal Surgical Associates of Birmingham, P.C.
Jurisdiction: Alabama
Legal type: Domestic Professional Corporation
Status: Exists
Date of registration: 15 Apr 2005 (20 years ago) (Companies founded in April 2005)
Entity Number: 000-240-982
Register Number: 000240982
ZIP code: 35205 (Companies in Jefferson, 35205)
County: Jefferson
Place of Formation: Jefferson County
Principal Address: BIRMINGHAM, AL
Registered Office Street Address: 2121 HIGHLAND AVENUEBIRMINGHAM, AL 35205
Authorized Capital: $1,000

Activities PRACTICE MEDICINE COLON/RECTAL

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1972558864 2006-05-23 2024-05-08 3400 INDEPENDENCE DR, HOMEWOOD, AL, 352095604, US 3400 INDEPENDENCE DR, HOMEWOOD, AL, 352095604, US

Contacts
Phone +1 205-933-1199
Fax 8664915373

Authorized person
Name DR. BRIAN TRUETT GUFFIN
Role PRESIDENT
Phone 2059331199

Taxonomy
Taxonomy Code 174400000X - Specialist
License Number 15312 & 23439
State AL
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 529924730
State AL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
COLON & RECTAL SURGICAL ASSOCIATES OF BIRMINGHAM, PC 401(K) PLAN 2023 202683579 2024-06-14 COLON & RECTAL SURGICAL ASSOCIATES OF BIRMINGHAM 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 2059331199
Plan sponsor’s address 3400 INDEPENDENCE DRIVE, HOMEWOOD, AL, 35209

Signature of
Role Plan administrator
Date 2024-06-14
Name of individual signing BRIAN LASKER
COLON & RECTAL SURGICAL ASSOCIATES OF BIRMINGHAM, PC 401(K) PLAN 2022 202683579 2023-07-24 COLON & RECTAL SURGICAL ASSOCIATES OF BIRMINGHAM 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 2059331199
Plan sponsor’s address 3400 INDEPENDENCE DRIVE, HOMEWOOD, AL, 35209

Signature of
Role Plan administrator
Date 2023-07-24
Name of individual signing BRIAN LASKER
COLON & RECTAL SURGICAL ASSOCIATES OF BIRMINGHAM, PC 401(K) PLAN 2021 202683579 2022-06-23 COLON & RECTAL SURGICAL ASSOCIATES OF BIRMINGHAM 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 2059331199
Plan sponsor’s address 3400 INDEPENDENCE DRIVE, HOMEWOOD, AL, 35209

Signature of
Role Plan administrator
Date 2022-06-23
Name of individual signing BRIAN LASKER
COLON & RECTAL SURGICAL ASSOCIATES OF BIRMINGHAM, PC 401(K) PLAN 2020 202683579 2021-06-22 COLON & RECTAL SURGICAL ASSOCIATES OF BIRMINGHAM 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 2059331199
Plan sponsor’s address 3400 INDEPENDENCE DRIVE, HOMEWOOD, AL, 35209

Signature of
Role Plan administrator
Date 2021-06-18
Name of individual signing BRIAN LASKER
COLON & RECTAL SURGICAL ASSOCIATES OF BIRMINGHAM, PC 401(K) PLAN 2019 202683579 2020-05-27 COLON & RECTAL SURGICAL ASSOCIATES OF BIRMINGHAM 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 2059331199
Plan sponsor’s address 3400 INDEPENDENCE DRIVE, HOMEWOOD, AL, 35209

Signature of
Role Plan administrator
Date 2020-05-27
Name of individual signing BJ LATSIS
COLON & RECTAL SURGICAL ASSOCIATES OF BIRMINGHAM, PC 401(K) PLAN 2018 202683579 2019-09-09 COLON & RECTAL SURGICAL ASSOCIATES OF BIRMINGHAM 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 2059331199
Plan sponsor’s address 3400 INDEPENDENCE DRIVE, HOMEWOOD, AL, 35209

Signature of
Role Plan administrator
Date 2019-09-08
Name of individual signing BJ LATSIS
COLON & RECTAL SURGICAL ASSOCIATES OF BIRMINGHAM, PC 401(K) PLAN 2017 202683579 2018-10-09 COLON & RECTAL SURGICAL ASSOCIATES OF BIRMINGHAM 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 2059331199
Plan sponsor’s address 3400 INDEPENDENCE DRIVE, HOMEWOOD, AL, 35209

Signature of
Role Plan administrator
Date 2018-10-09
Name of individual signing BJ LATSIS
COLON & RECTAL SURGICAL ASSOCIATES OF BIRMINGHAM, PC 401(K) PLAN 2016 202683579 2017-09-26 COLON & RECTAL SURGICAL ASSOCIATES OF BIRMINGHAM 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 2059331199
Plan sponsor’s address 3400 INDEPENDENCE DRIVE, HOMEWOOD, AL, 35209

Signature of
Role Plan administrator
Date 2017-09-26
Name of individual signing BJ LATSIS
COLON & RECTAL SURGICAL ASSOCIATES OF BIRMINGHAM, PC 401(K) PLAN 2015 202683579 2016-10-05 COLON & RECTAL SURGICAL ASSOCIATES OF BIRMINGHAM 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 2059331199
Plan sponsor’s address 3400 INDEPENDENCE DRIVE, HOMEWOOD, AL, 35209

Signature of
Role Plan administrator
Date 2016-10-05
Name of individual signing BJ LATSIS
COLON & RECTAL SURGICAL ASSOCIATES OF BIRMINGHAM, PC 401(K) PLAN 2014 202683579 2015-10-07 COLON & RECTAL SURGICAL ASSOCIATES OF BIRMINGHAM 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 2059331199
Plan sponsor’s address 3400 INDEPENDENCE DRIVE, HOMEWOOD, AL, 35209

Signature of
Role Plan administrator
Date 2015-10-07
Name of individual signing BJ LATSIS

Agent

Name Role
DOUGHTON, SUSAN Agent

Incorporator

Name Role
DOUGHTON, SUSAN Incorporator

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DOUGHTON, SUSAN

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Date of last update: 02 Aug 2024

Sources: Alabama Secretary of State

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