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Alabama Orthopaedic Sports Medicine, LLC

Details

Name: Alabama Orthopaedic Sports Medicine, LLC
Jurisdiction: Alabama
Legal type: Domestic Limited Liability Company
Status: Exists
Date of registration: 24 Apr 2013 (12 years ago) (Companies founded in April 2013)
Entity Number: 000-278-946
Register Number: 000278946
ZIP code: 36526 (Companies in Baldwin, 36526)
County: Baldwin
Place of Formation: Baldwin County
Registered Office Street Address: 27961 US HIGHWAY 98 STE 17DAPHNE, AL 36526

Activities PRACTICE OF ORTHOPAEDIC AND SPORTS MEDICINE

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1174960926 2013-06-03 2018-07-10 PO BOX 478, DAPHNE, AL, 365260478, US 6401 JORDAN RD, SUITE A, DAPHNE, AL, 365264728, US

Contacts
Phone +1 251-491-2676
Fax 2514912685

Authorized person
Name DR. DANIEL E MATTHEWS
Role SOLE MEMBER
Phone 2514912676

Taxonomy
Taxonomy Code 207XX0005X - Sports Medicine (Orthopaedic Surgery) Physician
License Number 21607
State AL
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 149441
State AL
Issuer RAILROAD MEDICARE
Number DU0298
State AL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
AOSM 401(K) PLAN 2023 462616658 2024-08-30 ALABAMA ORTHOPAEDIC SPORTS MEDICINE 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-01-01
Business code 621111
Sponsor’s telephone number 2514912676
Plan sponsor’s address 6401 JORDAN ROAD, STE. A, DAPHNE, AL, 36526
AOSM 401(K) PLAN 2022 462616658 2023-06-21 ALABAMA ORTHOPAEDIC SPORTS MEDICINE 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-01-01
Business code 621111
Sponsor’s telephone number 2514912676
Plan sponsor’s address 6401 JORDAN ROAD, STE. A, DAPHNE, AL, 36526

Signature of
Role Plan administrator
Date 2023-06-21
Name of individual signing JOHN ANSAY
AOSM 401(K) PLAN 2021 462616658 2022-06-07 ALABAMA ORTHOPAEDIC SPORTS MEDICINE 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-01-01
Business code 621111
Sponsor’s telephone number 2514912676
Plan sponsor’s address 6401 JORDAN ROAD, STE. A, DAPHNE, AL, 36526

Plan administrator’s name and address
Administrator’s EIN 721386027
Plan administrator’s name PLANTECH, LLP
Plan administrator’s address 2205 CAHABA VALLEY DRIVE, BIRMINGHAM, AL, 35242
Administrator’s telephone number 2059801603

Signature of
Role Plan administrator
Date 2022-06-07
Name of individual signing JOHN ANSAY
AOSM 401(K) PLAN 2020 462616658 2021-09-24 ALABAMA ORTHOPAEDIC SPORTS MEDICINE 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-01-01
Business code 621111
Sponsor’s telephone number 2514912676
Plan sponsor’s address 6401 JORDAN ROAD, SUITE A, DAPHNE, AL, 36526

Plan administrator’s name and address
Administrator’s EIN 721386027
Plan administrator’s name PLANTECH, LLP
Plan administrator’s address 2205 CAHABA VALLEY DRIVE, BIRMINGHAM, AL, 35242
Administrator’s telephone number 2059801603

Signature of
Role Plan administrator
Date 2021-09-24
Name of individual signing JOHN ANSAY
AOSM 401(K) PLAN 2019 462616658 2020-07-27 ALABAMA ORTHOPAEDIC SPORTS MEDICINE 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-01-01
Business code 621111
Sponsor’s telephone number 2514912676
Plan sponsor’s address 6401 JORDAN ROAD, SUITE A, DAPHNE, AL, 36526

Plan administrator’s name and address
Administrator’s EIN 721386027
Plan administrator’s name PLANTECH, LLP
Plan administrator’s address 2205 CAHABA VALLEY DRIVE, BIRMINGHAM, AL, 35242
Administrator’s telephone number 2059801603

Signature of
Role Plan administrator
Date 2020-07-27
Name of individual signing KATHY BITTLE
AOSM 401(K) PLAN 2018 462616658 2019-06-14 ALABAMA ORTHOPAEDIC SPORTS MEDICINE 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-01-01
Business code 621111
Sponsor’s telephone number 2514912676
Plan sponsor’s address 6401 JORDAN ROAD, SUITE A, DAPHNE, AL, 36526

Plan administrator’s name and address
Administrator’s EIN 721386027
Plan administrator’s name PLANTECH, LLP
Plan administrator’s address 2205 CAHABA VALLEY DRIVE, BIRMINGHAM, AL, 35242
Administrator’s telephone number 2059801603

Signature of
Role Plan administrator
Date 2019-06-14
Name of individual signing KATHY BITTLE
AOSM 401(K) PLAN 2017 462616658 2018-05-07 ALABAMA ORTHOPAEDIC SPORTS MEDICINE 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-01-01
Business code 621111
Sponsor’s telephone number 2514912676
Plan sponsor’s address 27961 U.S. HIGHWAY 98, SUITE 17, DAPHNE, AL, 36526

Plan administrator’s name and address
Administrator’s EIN 721386027
Plan administrator’s name PLANTECH, LLP
Plan administrator’s address 2205 CAHABA VALLEY DRIVE, BIRMINGHAM, AL, 35242
Administrator’s telephone number 2059801603

Signature of
Role Plan administrator
Date 2018-05-07
Name of individual signing KATHY BITTLE
AOSM 401(K) PLAN 2016 462616658 2017-05-02 ALABAMA ORTHOPAEDIC SPORTS MEDICINE 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-01-01
Business code 621111
Sponsor’s telephone number 2514912676
Plan sponsor’s address 27961 U.S. HIGHWAY 98, SUITE 17, DAPHNE, AL, 36526

Plan administrator’s name and address
Administrator’s EIN 721386027
Plan administrator’s name PLANTECH, LLP
Plan administrator’s address 2205 CAHABA VALLEY DRIVE, BIRMINGHAM, AL, 35242
Administrator’s telephone number 2059801603

Signature of
Role Plan administrator
Date 2017-05-02
Name of individual signing KATHY BITTLE
AOSM 401(K) PLAN 2015 462616658 2016-07-13 ALABAMA ORTHOPAEDIC SPORTS MEDICINE 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-01-01
Business code 621111
Sponsor’s telephone number 2514912676
Plan sponsor’s address P.O. BOX 478, DAPHNE, AL, 36526

Signature of
Role Plan administrator
Date 2016-07-13
Name of individual signing DANIEL MATTHEWS
AOSM 401(K) PLAN 2014 462616658 2015-06-26 ALABAMA ORTHOPAEDIC SPORTS MEDICINE 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-01-01
Business code 621111
Sponsor’s telephone number 2514912676
Plan sponsor’s address P.O. BOX 478, DAPHNE, AL, 36526

Signature of
Role Plan administrator
Date 2015-06-26
Name of individual signing DANIEL MATTHEWS

Agent

Name Role Address
MATTHEWS, DANIEL E Agent 29891 WOODROW LANE SUITE 400 & 500DAPHNE, AL 36526

Organizer

Name Role Address
MATTHEWS, DANIEL E Organizer 29891 WOODROW LANE SUITE 400 & 500DAPHNE, AL 36526

Related by officers

MATTHEWS, DANIEL E

Fairhope Surgical Center, LLC Bayside Medical Missions and Educational Outreach, Inc.

Related by address

No related companies by address

Date of last update: 02 Aug 2024

Sources: Alabama Secretary of State

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