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Southeast Physician Network, P.C.

Details

Name: Southeast Physician Network, P.C.
Jurisdiction: Alabama
Legal type: Domestic Professional Corporation
Status: Exists
Date of registration: 28 Sep 2009 (15 years ago)
Entity Number: 000-262-090
Register Number: 000262090
County: Tuscaloosa
Place of Formation: Tuscaloosa County
Principal Address: TUSCALOOSA, AL
Registered Office Street Address: 1400 AFFLINK PLACE SUITE 101TUSCALOOSA, AL 35406
Registered Office Street Address ZIP Code: 35406
Authorized Capital: $1,000

Activities RENDER PROFESSIONAL SERVICES

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1255813119 2018-09-06 2024-05-21 509 ENERGY CENTER BLVD STE 804, NORTHPORT, AL, 354732798, US 1410 MCFARLAND BLVD N, TUSCALOOSA, AL, 354062209, US

Contacts
Phone +1 205-366-9740
Fax 2053449992
Phone +1 205-345-8208
Fax 2053458209

Authorized person
Name PAMELA HARPER
Role CREDENTIALING
Phone 2053669740

Taxonomy
Taxonomy Code 207RH0003X - Hematology & Oncology Physician
Is Primary Yes
Taxonomy Code 261QR0200X - Radiology Clinic/Center
Is Primary No

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
SOUTHEAST PHYSICIAN NETWORK, P.C. 401(K) PLAN 2018 270996600 2019-05-06 SOUTHEAST PHYSICIAN NETWORK, P.C. 95
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621111
Sponsor’s telephone number 2053458208
Plan sponsor’s address 1410 MCFARLAND BLVD., NORTH, TUSCALOOSA, AL, 35406

Signature of
Role Plan administrator
Date 2019-05-06
Name of individual signing STEVE MITCHELL
SOUTHEAST PHYSICIAN NETWORK, P. C. 401(K) PLAN 2018 270996600 2019-07-09 SOUTHEAST PHYSICIAN NETWORK, P.C. 109
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621111
Sponsor’s telephone number 2053458208
Plan sponsor’s address 1410 MCFARLAND BLVD., NORTH, TUSCALOOSA, AL, 35406

Signature of
Role Plan administrator
Date 2019-07-09
Name of individual signing STEVE MITCHELL
SOUTHEAST PHYSICIAN NETWORK, P.C. 401(K) PLAN 2017 270996600 2018-07-25 SOUTHEAST PHYSICIAN NETWORK, P.C. 71
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621111
Sponsor’s telephone number 2053458208
Plan sponsor’s address 1410 MCFARLAND BLVD., NORTH, TUSCALOOSA, AL, 35406

Signature of
Role Plan administrator
Date 2018-07-24
Name of individual signing STEVE MITCHELL
SOUTHEAST PHYSICIAN NETWORK, P.C. 401(K) PLAN 2016 270996600 2017-05-02 SOUTHEAST PHYSICIAN NETWORK, P.C. 89
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621111
Sponsor’s telephone number 2053458208
Plan sponsor’s address 1410 MCFARLAND BLV., NORTH, TUSCALOOSA, AL, 35406

Signature of
Role Plan administrator
Date 2017-05-02
Name of individual signing DEANNA OSWALT
SOUTHEAST PHYSICIAN NETWORK, P.C. 401(K) PLAN 2015 270996600 2016-05-06 SOUTHEAST PHYSICIAN NETWORK, P.C. 54
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621111
Sponsor’s telephone number 2053458208
Plan sponsor’s address 1410 MCFARLAND BLV., NORTH, TUSCALOOSA, AL, 35406

Signature of
Role Plan administrator
Date 2016-05-06
Name of individual signing DEANNA OSWALT
SOUTHEAST PHYSICIAN NETWORK, P.C. 401(K) PLAN 2014 270996600 2015-05-12 SOUTHEAST PHYSICIAN NETWORK, P.C. 56
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621111
Sponsor’s telephone number 2053458208
Plan sponsor’s address 1410 MCFARLAND BLV., NORTH, TUSCALOOSA, AL, 35406

Signature of
Role Plan administrator
Date 2015-05-12
Name of individual signing DEANNA OSWALT
Role Employer/plan sponsor
Date 2015-05-12
Name of individual signing DEANNA OSWALT
SOUTHEAST PHYSICIAN NETWORK, P.C. 401(K) PLAN 2013 270996600 2014-05-07 SOUTHEAST PHYSICIAN NETWORK, P.C. 64
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621111
Sponsor’s telephone number 2053458208
Plan sponsor’s address 1410 MCFARLAND BLV., NORTH, TUSCALOOSA, AL, 35406

Signature of
Role Plan administrator
Date 2014-05-07
Name of individual signing DEANNA OSWALT
Role Employer/plan sponsor
Date 2014-05-07
Name of individual signing DEANNA OSWALT
SOUTHEAST PHYSICIAN NETWORK, P.C. 401(K) PLAN 2012 270996600 2013-06-17 SOUTHEAST PHYSICIAN NETWORK, P.C. 61
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621111
Sponsor’s telephone number 2053458208
Plan sponsor’s address 1410 MCFARLAND BLV., NORTH, TUSCALOOSA, AL, 35406

Signature of
Role Plan administrator
Date 2013-06-17
Name of individual signing DEANNA OSWALT
Role Employer/plan sponsor
Date 2013-06-17
Name of individual signing DEANNA OSWALT
SOUTHEAST PHYSICIAN NETWORK, P.C. 401(K) PLAN 2011 270996600 2012-05-24 SOUTHEAST PHYSICIAN NETWORK, P.C. 64
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621111
Sponsor’s telephone number 2053458208
Plan sponsor’s address 1410 MCFARLAND BLV., NORTH, TUSCALOOSA, AL, 35406

Plan administrator’s name and address
Administrator’s EIN 270996600
Plan administrator’s name SOUTHEAST PHYSICIAN NETWORK, P.C.
Plan administrator’s address 1410 MCFARLAND BLV., NORTH, TUSCALOOSA, AL, 35406
Administrator’s telephone number 2053458208

Signature of
Role Plan administrator
Date 2012-05-24
Name of individual signing DEANNA OSWALT
SOUTHEAST PHYSICIAN NETWORK, P.C. 401(K) PLAN 2010 270996600 2011-07-08 SOUTHEAST PHYSICIAN NETWORK, P.C. 44
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621111
Sponsor’s telephone number 2053458208
Plan sponsor’s address 1410 MCFARLAND BLV., NORTH, TUSCALOOSA, AL, 35406

Plan administrator’s name and address
Administrator’s EIN 270996600
Plan administrator’s name SOUTHEAST PHYSICIAN NETWORK, P.C.
Plan administrator’s address 1410 MCFARLAND BLV., NORTH, TUSCALOOSA, AL, 35406
Administrator’s telephone number 2053458208

Signature of
Role Plan administrator
Date 2011-07-08
Name of individual signing DEANNA OSWALT
Role Employer/plan sponsor
Date 2011-07-08
Name of individual signing DEANNA OSWALT

Agent

Name Role
STEVE MITCHELL Agent

Incorporator

Name Role
SANFORD, SHELBY P SR Incorporator

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STEVE MITCHELL

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SANFORD, SHELBY P SR

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1400 AFFLINK PLACE SUITE 101TUSCALOOSA, AL 35406

Alabama Cancer Care, LLC Alabama Cancer Care Holdings, LLC

Date of last update: 02 Aug 2024

Sources: Alabama Secretary of State

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