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Shades Valley Dermatology, LLC

Details

Name: Shades Valley Dermatology, LLC
Jurisdiction: Alabama
Legal type: Domestic Limited Liability Company
Status: Exists
Date of registration: 23 May 2016 (8 years ago)
Entity Number: 000-363-286
Register Number: 000363286
County: Jefferson
Place of Formation: Jefferson County
Registered Office Street Address: 420 NORTH 20TH STREET SUITE 3400BIRMINGHAM, AL 35203
Registered Office Street Address ZIP Code: 35203

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1831548668 2016-06-13 2016-08-05 813 SHADES CREEK PKWY, STE 205, BIRMINGHAM, AL, 352094542, US 813 SHADES CREEK PKWY, STE 205, BIRMINGHAM, AL, 352094542, US

Contacts
Phone +1 205-578-1799
Fax 2055783158

Authorized person
Name KATHERINE H FLANAGAN
Role OWNER/PHYSICIAN
Phone 2055781799

Taxonomy
Taxonomy Code 207N00000X - Dermatology Physician
License Number 23903
State AL
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
SHADES VALLEY DERMATOLOGY 401(K) PLAN 2023 812740858 2024-06-25 SHADES VALLEY DERMATOLOGY, LLC 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-01-01
Business code 621111
Sponsor’s telephone number 2055781799
Plan sponsor’s address 813 SHADES CREEK PARKWAY #205, BIRMINGHAM, AL, 35209
SHADES VALLEY DERMATOLOGY 401(K) PLAN 2022 812740858 2023-08-24 SHADES VALLEY DERMATOLOGY, LLC 17
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-01-01
Business code 621111
Sponsor’s telephone number 2055781799
Plan sponsor’s address 813 SHADES CREEK PARKWAY #205, BIRMINGHAM, AL, 35209
SHADES VALLEY DERMATOLOGY 401(K) PLAN 2021 812740858 2022-09-01 SHADES VALLEY DERMATOLOGY, LLC 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-01-01
Business code 621111
Sponsor’s telephone number 2055781799
Plan sponsor’s address 813 SHADES CREEK PARKWAY #205, BIRMINGHAM, AL, 35209
SHADES VALLEY DERMATOLOGY 401(K) PLAN 2020 812740858 2021-09-17 SHADES VALLEY DERMATOLOGY, LLC 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-01-01
Business code 621111
Sponsor’s telephone number 2055781799
Plan sponsor’s address 813 SHADES CREEK PARKWAY #205, BIRMINGHAM, AL, 35209
SHADES VALLEY DERMATOLOGY 401(K) PLAN 2019 812740858 2020-09-23 SHADES VALLEY DERMATOLOGY, LLC 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-01-01
Business code 621111
Sponsor’s telephone number 2055781799
Plan sponsor’s address 813 SHADES CREEK PARKWAY #205, BIRMINGHAM, AL, 35209
SHADES VALLEY DERMATOLOGY 401(K) PLAN 2018 812740858 2019-09-09 SHADES VALLEY DERMATOLOGY, LLC 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-01-01
Business code 621111
Sponsor’s telephone number 2055781799
Plan sponsor’s address 813 SHADES CREEK PARKWAY #205, BIRMINGHAM, AL, 35209

Agent

Name Role Address
BOGARD, HOWARD E ESQ Agent 420 NORTH 20TH ST SUITE 3400BIRMINGHAM, AL 35203

Organizer

Name Role Address
BOGARD, HOWARD E ESQ Organizer 420 NORTH 20TH ST SUITE 3400BIRMINGHAM, AL 35203

Related by officers

BOGARD, HOWARD E ESQ

JAS Consulting, LLC

Related by address

420 NORTH 20TH STREET SUITE 3400BIRMINGHAM, AL 35203

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Date of last update: 04 Aug 2024

Sources: Alabama Secretary of State

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