| Name: | Alabama Spine & Joint Center, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Dissolved |
| Date of registration: | 12 Apr 2007 (18 years ago) (Companies founded in April 2007) |
| Date of dissolution: | 15 Jul 2011 |
| Entity Number: | 000-252-200 |
| Register Number: | 000252200 |
| ZIP code: | 35209 (Companies in Jefferson, 35209) |
| County: | Jefferson |
| Place of Formation: | Jefferson County |
| Principal Address: | BIRMINGHAM, AL |
| Registered Office Street Address: | 513 BROOKWOOD BLVD STE 375BIRMINGHAM, AL 35209 |
| Authorized Capital: | $5,000 |
Activities
PRACTICE OF ORTHOPEDICS
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1730304338 | 2007-04-17 | 2008-04-20 | 513 BROOKWOOD BLVD, SUITE 350, BIRMINGHAM, AL, 352096862, US | 513 BROOKWOOD BLVD, SUITE 350, BIRMINGHAM, AL, 352096862, US | |||||||||||||||||||||
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| Phone | +1 205-802-4577 |
| Fax | 2058024579 |
| Phone | +1 205-824-8201 |
Authorized person
| Name | JOHN CUCKLER |
| Role | PHYSICIAN |
| Phone | 2058024577 |
Taxonomy
| Taxonomy Code | 207X00000X - Orthopaedic Surgery Physician |
| License Number | 23520 |
| State | AL |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ALABAMA SPINE & JOINT CENTER, P.C. 401K PLAN | 2010 | 208831669 | 2011-05-05 | ALABAMA SPINE & JOINT CENTER, P.C. | 17 | |||||||||||||||||||||||||||||||||||||
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| Administrator’s EIN | 208831669 |
| Plan administrator’s name | ALABAMA SPINE & JOINT CENTER, P.C. |
| Plan administrator’s address | 3436 OAK CANYON CIRCLE, BIRMINGHAM, AL, 35243 |
| Administrator’s telephone number | 2058070138 |
Signature of
| Role | Plan administrator |
| Date | 2011-05-05 |
| Name of individual signing | KENNETH A. JAFFE, M.D. |
| Role | Employer/plan sponsor |
| Date | 2011-05-05 |
| Name of individual signing | KENNETH A. JAFFE, M.D. |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2007-06-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 2058024577 |
| Plan sponsor’s address | 513 BROOKWOOD BOULEVARD, SUITE 375, BIRMINGHAM, AL, 352097825 |
Plan administrator’s name and address
| Administrator’s EIN | 208831669 |
| Plan administrator’s name | ALABAMA SPINE & JOINT CENTER, P.C. |
| Plan administrator’s address | 513 BROOKWOOD BOULEVARD, SUITE 375, BIRMINGHAM, AL, 352097825 |
| Administrator’s telephone number | 2058024577 |
Signature of
| Role | Plan administrator |
| Date | 2010-07-12 |
| Name of individual signing | KENNETH A. JAFFE, M.D. |
| Role | Employer/plan sponsor |
| Date | 2010-07-12 |
| Name of individual signing | KENNETH A. JAFFE, M.D. |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2007-06-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 2058024577 |
| Plan sponsor’s address | 513 BROOKWOOD BOULEVARD, SUITE 375, BIRMINGHAM, AL, 352097825 |
Plan administrator’s name and address
| Administrator’s EIN | 208831669 |
| Plan administrator’s name | ALABAMA SPINE & JOINT CENTER, P.C. |
| Plan administrator’s address | 513 BROOKWOOD BOULEVARD, SUITE 375, BIRMINGHAM, AL, 352097825 |
| Administrator’s telephone number | 2058024577 |
Signature of
| Role | Plan administrator |
| Date | 2010-07-09 |
| Name of individual signing | KENNETH A. JAFFE, M.D. |
| Role | Employer/plan sponsor |
| Date | 2010-07-09 |
| Name of individual signing | KENNETH A. JAFFE, M.D. |
| Name | Role |
|---|---|
| APPELL, SCOTT V | Agent |
| Name | Role | Address |
|---|---|---|
| LEVY, JACK B | Incorporator | 1819 FIFTH AVENUE NBIRMINGHAM, AL 35203 |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
