Powell Orthopedics & Sports Medicine, P.C.

Contacts

Phone	+1 205-877-9191

Authorized person

Name	DR. THOMAS E POWELL
Role	PRESIDENT
Phone	2058779191

Taxonomy

Taxonomy Code	207X00000X - Orthopaedic Surgery Physician
License Number	19612
State	AL
Is Primary	Yes

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2011-01-01
Business code	621111
Sponsor’s telephone number	2058779191
Plan sponsor’s address	2020 CANYON ROAD, SUITE 200, VESTAVIA HILLS, AL, 352161959

File	View Page
Three-digit plan number (PN)	002
Effective date of plan	2012-01-01
Business code	621111
Sponsor’s telephone number	2058779191
Plan sponsor’s address	2020 CANYON ROAD, SUITE 200, VESTAVIA HILLS, AL, 35216

File	View Page
Three-digit plan number (PN)	002
Effective date of plan	2012-01-01
Business code	621111
Sponsor’s telephone number	2058779191
Plan sponsor’s address	513 BROOKWOOD BLVD., SUITE 400, BIRMINGHAM, AL, 352097822

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2011-01-01
Business code	621111
Sponsor’s telephone number	2058779191
Plan sponsor’s address	2020 CANYON ROAD, SUITE 200, VESTAVIA HILLS, AL, 352161959

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2011-01-01
Business code	621111
Sponsor’s telephone number	2058779191
Plan sponsor’s address	2020 CANYON ROAD, SUITE 200, VESTAVIA HILLS, AL, 352161959

File	View Page
Three-digit plan number (PN)	002
Effective date of plan	2012-01-01
Business code	621111
Sponsor’s telephone number	2058779191
Plan sponsor’s address	513 BROOKWOOD BLVD., SUITE 400, BIRMINGHAM, AL, 352097822

File	View Page
Three-digit plan number (PN)	002
Effective date of plan	2012-01-01
Business code	621111
Sponsor’s telephone number	2058779191
Plan sponsor’s address	513 BROOKWOOD BLVD., SUITE 400, BIRMINGHAM, AL, 352097822

File	View Page
Three-digit plan number (PN)	002
Effective date of plan	2012-01-01
Business code	621111
Sponsor’s telephone number	2058779191
Plan sponsor’s address	513 BROOKWOOD BLVD., SUITE 400, BIRMINGHAM, AL, 352097822

File	View Page
Three-digit plan number (PN)	002
Effective date of plan	2012-01-01
Business code	621111
Sponsor’s telephone number	2058779191
Plan sponsor’s address	513 BROOKWOOD BLVD. SUITE 400, BIRMINGHAM, AL, 352097822

Signature of

Role	Plan administrator
Date	2014-10-13
Name of individual signing	THOMAS E. POWELL

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2011-01-01
Business code	621111
Sponsor’s telephone number	2058779191
Plan sponsor’s address	513 BROOKWOOD BLVD. SUITE 200, BIRMINGHAM, AL, 352095807

Signature of

Role	Plan administrator
Date	2014-09-16
Name of individual signing	THOMAS E. POWELL
Role	Employer/plan sponsor
Date	2014-09-16
Name of individual signing	THOMAS E. POWELL