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Scottsboro Family Physicians, P.C.

Details

Name: Scottsboro Family Physicians, P.C.
Jurisdiction: Alabama
Legal type: Domestic Professional Corporation
Status: Exists
Date of registration: 06 Aug 2007 (17 years ago) (Companies founded in August 2007)
Entity Number: 000-253-803
Register Number: 000253803
ZIP code: 35768 (Companies in Jackson, 35768)
County: Jackson
Place of Formation: Jackson County
Principal Address: SCOTTSBORO, AL 35768
Registered Office Street Address: 1108 BROAD ST STE ASCOTTSBORO, AL 35768
Authorized Capital: $1,000

Activities PRACTICE MEDICINE

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1700365756 2018-08-10 2020-11-03 1302 S BROAD ST, SCOTTSBORO, AL, 357682605, US 79 BANK ST, STEVENSON, AL, 357723781, US

Contacts
Phone +1 256-218-4080
Fax 2562183147
Phone +1 256-548-3104
Fax 2565483106

Authorized person
Name JENNIFER COOKE WHITE
Role MD/OWNER
Phone 2562184080

Taxonomy
Taxonomy Code 261QP2300X - Primary Care Clinic/Center
Is Primary No
Taxonomy Code 261QR1300X - Rural Health Clinic/Center
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
SCOTTSBORO FAMILY PHYSICIANS 401 (K) PLAN 2020 260459228 2021-07-08 SCOTTSBORO FAMILY PHYSICIANS 17
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 541990
Sponsor’s telephone number 2562184080
Plan sponsor’s address 1302 S BROAD ST, SCOTTSBORO, AL, 357682605

Signature of
Role Plan administrator
Date 2021-07-08
Name of individual signing JENNIFER C. WHITE
SCOTTSBORO FAMILY PHYSICIANS 401 (K) PLAN 2019 260459228 2020-07-28 SCOTTSBORO FAMILY PHYSICIANS 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 541990
Sponsor’s telephone number 2562184080
Plan sponsor’s address 1302 S BROAD ST, SCOTTSBORO, AL, 357682605

Signature of
Role Plan administrator
Date 2020-07-28
Name of individual signing JENNIFER C. WHITE
SCOTTSBORO FAMILY PHYSICIANS 401 (K) PLAN 2018 260459228 2019-07-29 SCOTTSBORO FAMILY PHYSICIANS 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 541990
Sponsor’s telephone number 2562184080
Plan sponsor’s address 1302 S BROAD ST, SCOTTSBORO, AL, 357682605

Signature of
Role Plan administrator
Date 2019-07-29
Name of individual signing JENNIFER C. WHITE
SCOTTSBORO FAMILY PHYSICIANS 401 (K) PLAN 2017 260459228 2018-08-22 SCOTTSBORO FAMILY PHYSICIANS 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 541990
Sponsor’s telephone number 2562184080
Plan sponsor’s address 1302 S BROAD ST, SCOTTSBORO, AL, 357682605

Signature of
Role Plan administrator
Date 2018-08-22
Name of individual signing JENNIFER C. WHITE
SCOTTSBORO FAMILY PHYSICIANS 401 (K) PLAN 2016 260459228 2017-09-13 SCOTTSBORO FAMILY PHYSICIANS 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 541990
Sponsor’s telephone number 2562184080
Plan sponsor’s address 1302 SOUTH BROAD ST, SCOTTSBORO, AL, 357682605

Signature of
Role Plan administrator
Date 2017-09-13
Name of individual signing JENNIFER C. WHITE
SCOTTSBORO FAMILY PHYSICIANS 401 (K) PLAN 2015 260459228 2016-09-07 SCOTTSBORO FAMILY PHYSICIANS 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 541990
Sponsor’s telephone number 2562184080
Plan sponsor’s address 1302 S BROAD ST, SCOTTSBORO, AL, 357682605

Signature of
Role Plan administrator
Date 2016-09-07
Name of individual signing JENNIFER C. WHITE
SCOTTSBORO FAMILY PHYSICIANS 401 (K) PLAN 2014 260459228 2015-09-30 SCOTTSBORO FAMILY PHYSICIANS 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 541990
Sponsor’s telephone number 2562184080
Plan sponsor’s address 1108 S BROAD ST STE A, SCOTTSBORO, AL, 357682605

Signature of
Role Plan administrator
Date 2015-09-30
Name of individual signing JENNIFER C. WHITE
SCOTTSBORO FAMILY PHYSICIANS 401 (K) PLAN 2013 260459228 2014-10-13 SCOTTSBORO FAMILY PHYSICIANS 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 111100
Sponsor’s telephone number 2562184080
Plan sponsor’s address 1108 S BROAD ST STE A, SCOTTSBORO, AL, 357682514

Signature of
Role Plan administrator
Date 2014-10-13
Name of individual signing JENNIFER C WHITE MD
SCOTTSBORO FAMILY PHYSICIANS 401 (K) PLAN 2012 260459228 2013-10-10 SCOTTSBORO FAMILY PHYSICIANS 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 111100
Sponsor’s telephone number 2562184080
Plan sponsor’s address 1108 S BROAD ST STE A, ATTN DR. JENNIFER C WHITE, SCOTTSBORO, AL, 357682514

Signature of
Role Plan administrator
Date 2013-10-10
Name of individual signing JENNIFER C WHITE MD
SCOTTSBORO FAMILY PHYSICIANS 401 (K) PLAN 2011 260459228 2012-07-25 SCOTTSBORO FAMILY PHYSICIANS 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 812990
Sponsor’s telephone number 2562184080
Plan sponsor’s address 1108 S BROAD ST STE A, ATTN DR. JENNIFER C WHITE, SCOTTSBORO, AL, 357682514

Plan administrator’s name and address
Administrator’s EIN 260459228
Plan administrator’s name SCOTTSBORO FAMILY PHYSICIANS
Plan administrator’s address 1108 S BROAD ST STE A, ATTN DR. JENNIFER C WHITE, SCOTTSBORO, AL, 357682514
Administrator’s telephone number 2562184080

Signature of
Role Plan administrator
Date 2012-07-25
Name of individual signing JENNIFER C WHITE MD

Agent

Name Role Address
WHITE, JENNIFER C Agent 38 CREEK CIRCLESCOTTSBORO, AL 35769

Incorporator

Name Role Address
FREDERICK, PAUL Incorporator 655 GALLATIN STREETHUNTSVILLE, AL 35801

Related by officers

WHITE, JENNIFER C

CoraLes Properties, LLC

FREDERICK, PAUL

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Related by address

SCOTTSBORO, AL 35768

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Date of last update: 02 Aug 2024

Sources: Alabama Secretary of State

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