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Whitehurst General Surgery, P.C.

Details

Name: Whitehurst General Surgery, P.C.
Jurisdiction: Alabama
Legal type: Domestic Professional Corporation
Status: Dissolved
Date of registration: 17 Oct 2007 (17 years ago)
Date of dissolution: 07 Jul 2016
Entity Number: 000-254-752
Register Number: 000254752
County: Houston
Place of Formation: Houston County
Principal Address: DOTHAN, AL
Registered Office Street Address: 112 HAVEN DR STE 2DOTHAN, AL 36301
Registered Office Street Address ZIP Code: 36301
Authorized Capital: $1,000

Activities MEDICAL PRACTICE

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1366678427 2009-06-03 2009-06-03 112 HAVEN DR, SUITE 1, DOTHAN, AL, 363012907, US 112 HAVEN DR, SUITE 1, DOTHAN, AL, 363012907, US

Contacts
Phone +1 334-671-5050
Fax 3346715070

Authorized person
Name DR. JEFFREY BRAY WHITEHURST
Role OWNER/PRESIDENT
Phone 3346715050

Taxonomy
Taxonomy Code 208600000X - Surgery Physician
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
WHITEHURST GENERAL SURGERY, P.C. PROFIT SHARING PLAN 2014 261260500 2015-11-30 WHITEHURST GENERAL SURGERY, P.C. 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-10-01
Business code 621111
Sponsor’s telephone number 3346730049
Plan sponsor’s address 112 HAVEN DRIVE, SUITE 1, DOTHAN, AL, 36301

Signature of
Role Plan administrator
Date 2015-11-30
Name of individual signing JEFFREY WHITEHURST, M.D.
WHITEHURST GENERAL SURGERY, P.C. PROFIT SHARING PLAN 2014 261260500 2015-07-30 WHITEHURST GENERAL SURGERY, P.C. 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-10-01
Business code 621111
Sponsor’s telephone number 3346730049
Plan sponsor’s address 112 HAVEN DRIVE, SUITE 1, DOTHAN, AL, 36301

Signature of
Role Plan administrator
Date 2015-07-30
Name of individual signing JEFFREY WHITEHURST, M.D.
WHITEHURST GENERAL SURGERY, P.C. PROFIT SHARING PLAN 2013 261260500 2014-06-30 WHITEHURST GENERAL SURGERY, P.C. 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-10-01
Business code 621111
Sponsor’s telephone number 3346730049
Plan sponsor’s address 112 HAVEN DRIVE, SUITE 1, DOTHAN, AL, 36301

Signature of
Role Plan administrator
Date 2014-06-30
Name of individual signing JEFFREY WHITEHURST, M.D.
WHITEHURST GENERAL SURGERY, P.C. PROFIT SHARING PLAN 2012 261260500 2013-06-27 WHITEHURST GENERAL SURGERY, P.C. 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-10-01
Business code 621111
Sponsor’s telephone number 3346730049
Plan sponsor’s address 112 HAVEN DRIVE, SUITE 1, DOTHAN, AL, 36301

Signature of
Role Plan administrator
Date 2013-06-27
Name of individual signing JEFFREY WHITEHURST, M.D.
WHITEHURST GENERAL SURGERY, P.C. PROFIT SHARING PLAN 2011 261260500 2012-05-10 WHITEHURST GENERAL SURGERY, P.C. 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-10-01
Business code 621111
Sponsor’s telephone number 3346730049
Plan sponsor’s address 112 HAVEN DRIVE, SUITE 1, DOTHAN, AL, 36301

Plan administrator’s name and address
Administrator’s EIN 261260500
Plan administrator’s name WHITEHURST GENERAL SURGERY, P.C.
Plan administrator’s address 112 HAVEN DRIVE, SUITE 1, DOTHAN, AL, 36301
Administrator’s telephone number 3346730049

Signature of
Role Plan administrator
Date 2012-05-10
Name of individual signing JEFFREY WHITEHURST, M.D.
WHITEHURST GENERAL SURGERY, P.C. PROFIT SHARING PLAN 2010 261260500 2011-04-01 WHITEHURST GENERAL SURGERY, P.C. 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-10-01
Business code 621111
Sponsor’s telephone number 3346730049
Plan sponsor’s address 112 HAVEN DRIVE, SUITE 1, DOTHAN, AL, 36301

Plan administrator’s name and address
Administrator’s EIN 261260500
Plan administrator’s name WHITEHURST GENERAL SURGERY, P.C.
Plan administrator’s address 112 HAVEN DRIVE, SUITE 1, DOTHAN, AL, 36301
Administrator’s telephone number 3346730049

Signature of
Role Plan administrator
Date 2011-04-01
Name of individual signing JEFFREY WHITEHURST, M.D.
WHITEHURST GENERAL SURGERY, P.C. PROFIT SHARING PLAN 2010 261260500 2011-04-01 WHITEHURST GENERAL SURGERY, P.C. 2
Three-digit plan number (PN) 001
Effective date of plan 2008-10-01
Business code 621111
Sponsor’s telephone number 3346730049
Plan sponsor’s address 112 HAVEN DRIVE, SUITE 1, DOTHAN, AL, 36301

Plan administrator’s name and address
Administrator’s EIN 261260500
Plan administrator’s name WHITEHURST GENERAL SURGERY, P.C.
Plan administrator’s address 112 HAVEN DRIVE, SUITE 1, DOTHAN, AL, 36301
Administrator’s telephone number 3346730049

Signature of
Role Plan administrator
Date 2011-04-01
Name of individual signing JEFFREY WHITEHURST, M.D.
Role Employer/plan sponsor
Date 2011-04-01
Name of individual signing D. BRUCE WOODHAM, MD

Agent

Name Role
WHITEHURST, JEFFREY B Agent

Incorporator

Name Role
WHITEHURST, JEFFREY B Incorporator

Related by officers

WHITEHURST, JEFFREY B

J & J OH, LLC

Related by address

DOTHAN, AL

A & M Electrical Construction Co., Inc. Acme Auction Company of Dothan, Inc. Acme Lease-A-Car, Inc. Acme Roofing and Sheet Metal Company, Inc. Adams Foods, Inc. Adams Trading Center Alabama Electric Company, Inc. of Dothan Art & Craft Hut, Inc. Southeastern Cabinet Co., Inc. Auto Electric Company of Alabama, Incorporated

112 HAVEN DR STE 2DOTHAN, AL 36301

L and N, L.L.C.

Date of last update: 02 Aug 2024

Sources: Alabama Secretary of State

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