| Name: | Hannahan Comprehensive Pain Care, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 30 May 2017 (7 years ago) |
| Entity Number: | 000-392-910 |
| Register Number: | 000392910 |
| Historical Names: |
Robert Hannahan Interventional Pain Specialist, P.C.
|
| County: | Coffee |
| Place of Formation: | Mobile County |
| Registered Office Street Address: | 1275 JAMES DRIVE SUITE BENTERPRISE, AL 36330 |
| Registered Office Street Address ZIP Code: | 36330 |
| Authorized Capital: | 5,000 |
| Paid Share Capital: | $1.00 |
Activities
TRANSACT ANY LAWFUL BUSINESS
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1972090991 | 2018-04-16 | 2018-05-31 | PO BOX 1747, MEMPHIS, TN, 381011747, US | 1275 JAMES DR STE B, ENTERPRISE, AL, 36330, US | |||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||
| Phone | +1 334-417-0450 |
| Fax | 8013154946 |
| Phone | +1 251-599-6445 |
Authorized person
| Name | ROBERT W HANNAHAN |
| Role | OWNER |
| Phone | 3344170450 |
Taxonomy
| Taxonomy Code | 207LP2900X - Pain Medicine (Anesthesiology) Physician |
| License Number | 20671 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 000060068 |
| State | AL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| HANNAHAN COMPREHENSIVE PAIN CARE 401(K) PLAN | 2023 | 825041721 | 2024-09-25 | HANNAHAN COMPREHENSIVE PAIN CARE | 4 | |||||||||||||||||||||||||||||||||
|
||||||||||||||||||||||||||||||||||||||
| Role | Plan administrator |
| Date | 2024-09-25 |
| Name of individual signing | MELISSA HANNAHAN |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2024-09-25 |
| Name of individual signing | MELISSA HANNAHAN |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2021-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 2512090901 |
| Plan sponsor’s address | 1275 JAMES DRIVE, ENTERPRISE, AL, 36330 |
Signature of
| Role | Plan administrator |
| Date | 2023-10-11 |
| Name of individual signing | ROBERT HANNAHAN |
| Name | Role | Address |
|---|---|---|
| HANNAHAN, ROBERT W | Agent | 122 PINE BROOK DRIVEMOBILE, AL 36608 |
| Name | Role | Address |
|---|---|---|
| HANNAHAN, ROBERT W | Director | 122 PINE BROOK DRIVEMOBILE, AL 36608 |
| Name | Role | Address |
|---|---|---|
| HANNAHAN, ROBERT W | Incorporator | 122 PINE BROOK DRIVEMOBILE, AL 36608 |
| Event Date | Event Type | Old Value | New Value |
|---|---|---|---|
| 2018-04-13 | Name Change | Robert Hannahan Interventional Pain Specialist, P.C. | Hannahan Comprehensive Pain Care, P.C. |
Date of last update: 13 Aug 2024
Sources: Alabama Secretary of State
