| Name: | Tuscaloosa Breast Center, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Dissolved |
| Date of registration: | 18 Sep 2012 (12 years ago) |
| Date of dissolution: | 20 Mar 2018 |
| Entity Number: | 000-267-593 |
| Register Number: | 000267593 |
| County: | Tuscaloosa |
| Place of Formation: | Tuscaloosa County |
| Registered Office Street Address: | 701 UNIVERSITY BLVD EAST, SUITE 807TUSCALOOSA, AL 35401 |
| Registered Office Street Address ZIP Code: | 35401 |
| Registered Office Mailing Address: | 2600 LOOP ROADTUSCALOOSA, AL 35405 |
| Registered Office Mailing Address ZIP Code: | 35405 |
| Authorized Capital: | 1,000 @$1 PV |
Activities
PROFESSIONAL MEDICAL SERVICES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1124372867 | 2012-11-02 | 2012-11-02 | 701 UNIVERSITY BLVD E, SUITE 606, TUSCALOOSA, AL, 354012086, US | 701 UNIVERSITY BLVD E, SUITE 606, TUSCALOOSA, AL, 354012086, US | |||||||||||||||||||||||||
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| Phone | +1 205-752-2501 |
| Fax | 2057592868 |
Authorized person
| Name | DR. LEE THOMAS |
| Role | PRESIDENT |
| Phone | 2057522501 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| License Number | 12102 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 0000036823 |
| State | AL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| TUSCALOOSA BREAST CENTER 401(K) PLAN | 2014 | 461041277 | 2015-10-22 | TUSCALOOSA BREAST CENTER | 2 | |||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2015-10-22 |
| Name of individual signing | DR. LEE THOMAS |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2013-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 2053446961 |
| Plan sponsor’s address | 701 UNIVERSITY BOULEVARD EAST, SUITE 807, TUSCALOOSA, AL, 35401 |
Signature of
| Role | Plan administrator |
| Date | 2015-10-05 |
| Name of individual signing | DR. LEE THOMAS |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2013-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 2053446961 |
| Plan sponsor’s address | 701 UNIVERSITY BOULEVARD EAST, SUITE 807, TUSCALOOSA, AL, 35401 |
Signature of
| Role | Plan administrator |
| Date | 2014-07-31 |
| Name of individual signing | DR. LEE THOMAS |
| Name | Role | Address |
|---|---|---|
| THOMAS, LEE | Agent | 71 WILLMOORE DRIVECAMDEN, AL 36726 |
| Name | Role | Address |
|---|---|---|
| THOMAS, LEE | Director | 71 WILLMOORE DRIVECAMDEN, AL 36726 |
| Name | Role | Address |
|---|---|---|
| THOMAS, LEE | Incorporator | 71 WILLMOORE DRIVECAMDEN, AL 36726 |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
