| Name: | ACIPCO Medical Group, Inc. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Corporation |
| Status: | Dissolved |
| Date of registration: | 06 Dec 2005 (19 years ago) (Companies founded in December 2005) |
| Date of dissolution: | 26 May 2020 |
| Entity Number: | 000-244-621 |
| Register Number: | 000244621 |
| ZIP code: | 35207 (Companies in Jefferson, 35207) |
| County: | Jefferson |
| Place of Formation: | Jefferson County |
| Registered Office Street Address: | 3200 16TH STREET NORTHBIRMINGHAM, AL 35207 |
| Principal Address: | BIRMINGHAM, AL |
| Authorized Capital: | $5,000 |
Activities
PROVIDE LICENSED PERSONNEL FOR PERFORMANCE OF MEDICAL SERVICES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1164575692 | 2007-01-19 | 2015-02-13 | PO BOX 12725, BIRMINGHAM, AL, 352026725, US | 3200 16TH ST N, BIRMINGHAM, AL, 352074202, US | |||||||||||||||||||||||||||||||
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| Phone | +1 205-325-8081 |
| Fax | 2053072719 |
| Phone | +1 205-325-7012 |
Authorized person
| Name | JOHNNY CURREN |
| Role | DIRECTOR OF PHARMACY |
| Phone | 2053258081 |
Taxonomy
| Taxonomy Code | 3336C0002X - Clinic Pharmacy |
| License Number | 112743 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 100002930 |
| State | AL |
| Issuer | PK |
| Number | 1988510 |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ACIPCO MEDICAL GROUP, INC. 401(K) PLAN | 2012 | 203892834 | 2015-02-06 | ACIPCO MEDICAL GROUP, INC. | 35 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Administrator’s EIN | 203892834 |
| Plan administrator’s name | ACIPCO MEDICAL GROUP, INC. |
| Plan administrator’s address | 3200 16TH STREET NORTH, BIRMINGHAM, AL, 35207 |
| Administrator’s telephone number | 2053258003 |
Number of participants as of the end of the plan year
| Active participants | 33 |
| Retired or separated participants receiving benefits | 0 |
| Other retired or separated participants entitled to future benefits | 1 |
| Deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 0 |
| Number of participants with account balances as of the end of the plan year | 22 |
| Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 0 |
Signature of
| Role | Plan administrator |
| Date | 2015-02-06 |
| Name of individual signing | ROLAND BRADFORD |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2015-02-06 |
| Name of individual signing | ROLAND BRADFORD |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2006-02-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 2053258003 |
| Plan sponsor’s address | P.O. BOX 12725, BIRMINGHAM, AL, 352022725 |
Plan administrator’s name and address
| Administrator’s EIN | 203892834 |
| Plan administrator’s name | ACIPCO MEDICAL GROUP, INC. |
| Plan administrator’s address | P.O. BOX 12725, BIRMINGHAM, AL, 352022725 |
| Administrator’s telephone number | 2053258003 |
Signature of
| Role | Plan administrator |
| Date | 2012-10-11 |
| Name of individual signing | ROLAND BRADFORD |
| Name | Role |
|---|---|
| PITTS, J W JR | Agent |
| Name | Role |
|---|---|
| PITTS, J W JR | Incorporator |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
