| Name: | Auburn Spine & Neurosurgery Center, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Dissolved |
| Date of registration: | 10 Feb 2006 (19 years ago) |
| Date of dissolution: | 13 Apr 2023 |
| Entity Number: | 000-245-726 |
| Register Number: | 000245726 |
| Historical Names: |
Auburn Neurosurgery, P. C.
|
| County: | Lee |
| Place of Formation: | Lee County |
| Principal Address: | AUBURN, AL |
| Registered Office Street Address: | 2320 MOORES MILL RD STE 250AUBURN, AL 36830 |
| Registered Office Street Address ZIP Code: | 36830 |
| Authorized Capital: | $1,000 |
Activities
MEDICAL PRACTICE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1336215680 | 2006-11-28 | 2013-08-16 | 560 DEVALL DRIVE, SUITE 301, AUBURN, AL, 36832, US | 560 DEVALL DRIVE, SUITE 301, AUBURN, AL, 36832, US | |||||||||||||||||||||||
|
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| Phone | +1 334-821-0466 |
| Fax | 3348214682 |
Authorized person
| Name | DR. WAYNE L WARREN JR. |
| Role | CEO M.D. |
| Phone | 3348210466 |
Taxonomy
| Taxonomy Code | 207T00000X - Neurological Surgery Physician |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 529928430 |
| State | AL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| AUBURN SPINE & NEUROSURGERY CENTER, P.C. 401(K) PLAN | 2010 | 204164283 | 2011-10-10 | AUBURN SPINE & NEUROSURGERY CENTER, P. C. | 8 | |||||||||||||||||||||||||||||||||||||
|
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| Administrator’s EIN | 204164283 |
| Plan administrator’s name | AUBURN SPINE & NEUROSURGERY CENTER, P. C. |
| Plan administrator’s address | 560 DEVALL DR., SUITE 301, AUBURN, AL, 36832 |
| Administrator’s telephone number | 3348210466 |
Signature of
| Role | Plan administrator |
| Date | 2011-10-10 |
| Name of individual signing | W LEE WARREN, M.D. |
| Role | Employer/plan sponsor |
| Date | 2011-10-10 |
| Name of individual signing | W LEE WARREN, M.D. |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2007-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 3348210466 |
| Plan sponsor’s address | 2320 MOORES MILL ROAD SUITE 250, AUBURN, AL, 368308441 |
Plan administrator’s name and address
| Administrator’s EIN | 204164283 |
| Plan administrator’s name | AUBURN NEUROSURGERY, P.C. |
| Plan administrator’s address | 2320 MOORES MILL ROAD SUITE 250, AUBURN, AL, 368308441 |
| Administrator’s telephone number | 3348210466 |
Signature of
| Role | Plan administrator |
| Date | 2010-09-13 |
| Name of individual signing | W LEE WARREN, M.D. |
| Role | Employer/plan sponsor |
| Date | 2010-09-13 |
| Name of individual signing | W LEE WARREN, M.D. |
| Name | Role |
|---|---|
| WARREN, W LEE | Agent |
| Name | Role |
|---|---|
| WARREN, W LEE | Incorporator |
| Event Date | Event Type | Old Value | New Value |
|---|---|---|---|
| 2010-04-30 | Name Change | Auburn Neurosurgery, P. C. | Auburn Spine & Neurosurgery Center, P.C. |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
