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KMKG Pain Management, P.C.

Details

Name: KMKG Pain Management, P.C.
Jurisdiction: Alabama
Legal type: Domestic Professional Corporation
Status: Exists
Date of registration: 21 Nov 2006 (18 years ago) (Companies founded in November 2006)
Entity Number: 000-249-996
Register Number: 000249996
ZIP code: 35501 (Companies in Walker, 35501)
County: Walker
Place of Formation: Walker County
Principal Address: JASPER, AL
Registered Office Street Address: 1603 FIRST AVENUE EASTJASPER, AL 35501
Authorized Capital: $1,000
Paid Share Capital: $1,000

Activities ANESTHESIOLOGY

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1487702643 2007-01-06 2022-07-21 PO BOX 1427, JASPER, AL, 355021427, US 3400 HIGHWAY 78 E, JASPER, AL, 355018907, US

Contacts
Phone +1 205-221-5454
Fax 2052215474
Phone +1 205-387-4741

Authorized person
Name GARY KEITH MORGAN
Role OWNER PRESIDENT
Phone 2053874741

Taxonomy
Taxonomy Code 207L00000X - Anesthesiology Physician
State AL
Is Primary No
Taxonomy Code 207LP2900X - Pain Medicine (Anesthesiology) Physician
State AL
Is Primary No
Taxonomy Code 367500000X - Certified Registered Nurse Anesthetist
State AL
Is Primary No

Other Provider Identifiers
Issuer MEDICAID
Number 999999
State AL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
KMKG PAIN MANAGEMENT, P.C. RETIREMENT TRUST 2014 205939595 2015-07-20 KMKG PAIN MANAGEMENT, P.C. 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-04-01
Business code 621498
Sponsor’s telephone number 2052215454
Plan sponsor’s address 1603 FIRST AVENUE EAST, JASPER, AL, 35501

Signature of
Role Plan administrator
Date 2015-07-20
Name of individual signing KEVIN GREENE
KMKG PAIN MANAGEMENT, P.C. RETIREMENT TRUST 2013 205939595 2014-06-11 KMKG PAIN MANAGEMENT, P.C. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-04-01
Business code 621498
Sponsor’s telephone number 2052215454
Plan sponsor’s address 1603 FIRST AVENUE EAST, JASPER, AL, 35501
KMKG PAIN MANAGEMENT, P.C. RETIREMENT TRUST 2012 205939595 2013-07-29 KMKG PAIN MANAGEMENT, P.C. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-04-01
Business code 621498
Sponsor’s telephone number 2052215454
Plan sponsor’s address 1603 FIRST AVENUE EAST, JASPER, AL, 35501

Signature of
Role Plan administrator
Date 2013-07-29
Name of individual signing KEVIN GREENE
KMKG PAIN MANAGEMENT, P.C. RETIREMENT TRUST 2011 205939595 2012-07-19 KMKG PAIN MANAGEMENT, P.C. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-04-01
Business code 621498
Sponsor’s telephone number 2052215454
Plan sponsor’s address 1603 FIRST AVENUE EAST, JASPER, AL, 35501

Plan administrator’s name and address
Administrator’s EIN 205939595
Plan administrator’s name KMKG PAIN MANAGEMENT, P.C.
Plan administrator’s address 1603 FIRST AVENUE EAST, JASPER, AL, 35501
Administrator’s telephone number 2052215454

Signature of
Role Plan administrator
Date 2012-07-19
Name of individual signing JOSEPH R. DOWNS, IV
Role Employer/plan sponsor
Date 2012-07-19
Name of individual signing GARY MORTON
KMKG PAIN MANAGEMENT, P.C. RETIREMENT TRUST 2010 205939595 2011-07-13 KMKG PAIN MANAGEMENT, P.C. 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-04-01
Business code 621498
Sponsor’s telephone number 2052215454
Plan sponsor’s address 1603 FIRST AVENUE EAST, JASPER, AL, 35501

Plan administrator’s name and address
Administrator’s EIN 205939595
Plan administrator’s name KMKG PAIN MANAGEMENT, P.C.
Plan administrator’s address 1603 FIRST AVENUE EAST, JASPER, AL, 35501
Administrator’s telephone number 2052215454

Signature of
Role Plan administrator
Date 2011-07-13
Name of individual signing GARY MORTON
Role Employer/plan sponsor
Date 2011-07-13
Name of individual signing GARY MORTON
KMKG PAIN MANAGEMENT, P.C. RETIREMENT TRUST 2009 205939595 2010-07-01 KMKG PAIN MANAGEMENT, P.C. 0
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-04-01
Business code 621498
Sponsor’s telephone number 2052215454
Plan sponsor’s address 1603 FIRST AVENUE EAST, JASPER, AL, 35501

Plan administrator’s name and address
Administrator’s EIN 205939595
Plan administrator’s name KMKG PAIN MANAGEMENT, P.C.
Plan administrator’s address 1603 FIRST AVENUE EAST, JASPER, AL, 35501
Administrator’s telephone number 2052215454

Signature of
Role Plan administrator
Date 2010-07-01
Name of individual signing GARY MORTON
Role Employer/plan sponsor
Date 2010-07-01
Name of individual signing GARY MORTON

Agent

Name Role Address
DOWNS, JOSEPH R IV Agent 1603 FIRST AVENUE EASTJASPER, AL 35501

Incorporator

Name Role
MORTON, KEITH Incorporator
GREENE, KEVIN Incorporator

Related by officers

DOWNS, JOSEPH R IV

Alabama Senate Republican Conference, Inc. Hope For Women The Master's Plan Ministries, Inc. KMKG Anesthesia, P.C. Downs & Associates CPA's, LLC Bentley, Piedmont, LLC Bentley & Parker, LLC Bentley Clayton, LLC Science Monkey, LLC Third & Fourth Real Estate, LLC

MORTON, KEITH

KMKG Anesthesia, P.C.

GREENE, KEVIN

Model City Fitness, Inc. Impact Mortgage Group, Inc. KMKG Anesthesia, P.C. Walker Comprehensive Pain Center, P.C.

Related by address

JASPER, AL

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1603 FIRST AVENUE EASTJASPER, AL 35501

The Master's Plan Ministries, Inc. KMKG Anesthesia, P.C. Science Monkey, LLC Two-Eighty Capital, LLC Pepper, LLC BDJKM, LLC Reed Media Consulting, LLC Two-Four Performance LLC

Date of last update: 02 Aug 2024

Sources: Alabama Secretary of State

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