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Integrated Medical Clinic LLC

Details

Name: Integrated Medical Clinic LLC
Jurisdiction: Alabama
Legal type: Domestic Limited Liability Company
Status: Exists
Date of registration: 01 Jun 2017 (7 years ago) (Companies founded in June 2017)
Entity Number: 000-393-095
Register Number: 000393095
ZIP code: 35901 (Companies in Etowah, 35901)
County: Etowah
Place of Formation: Etowah County
Registered Office Street Address: 512 SOUTH 4TH STREETGADSDEN, AL 35901

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1093237125 2017-07-11 2022-03-07 510 S 4TH ST, GADSDEN, AL, 359015217, US 510 S 4TH ST, GADSDEN, AL, 359015217, US

Contacts
Phone +1 256-438-5008
Fax 2564674009

Authorized person
Name KARL PETER M UY
Role DIRECTOR
Phone 2564385008

Taxonomy
Taxonomy Code 207Q00000X - Family Medicine Physician
License Number 32263
State AL
Is Primary Yes
Taxonomy Code 207RC0000X - Cardiovascular Disease Physician
License Number MD31385
State AL
Is Primary No
Taxonomy Code 207RC0001X - Clinical Cardiac Electrophysiology Physician
License Number MD31385
State AL
Is Primary No

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
INTEGRATED MEDICAL CLINIC LLC 401(K) PLAN 2023 821790890 2024-05-03 INTEGRATED MEDICAL CLINIC LLC 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-03-26
Business code 621111
Sponsor’s telephone number 2566221127
Plan sponsor’s address 510 S 4TH ST, GADSDEN, AL, 35901

Plan administrator’s name and address
Administrator’s EIN 474474775
Plan administrator’s name GUIDELINE, INC.
Plan administrator’s address 1412 CHAPIN AVENUE, BURLINGAME, CA, 94010
Administrator’s telephone number 8882283491

Signature of
Role Plan administrator
Date 2024-05-03
Name of individual signing QIAN LIU
INTEGRATED MEDICAL CLINIC LLC 401(K) PLAN 2022 821790890 2023-05-26 INTEGRATED MEDICAL CLINIC LLC 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-03-26
Business code 621111
Sponsor’s telephone number 2566221127
Plan sponsor’s address 510 S 4TH ST, GADSDEN, AL, 35901

Plan administrator’s name and address
Administrator’s EIN 474474775
Plan administrator’s name GUIDELINE, INC.
Plan administrator’s address 1412 CHAPIN AVENUE, BURLINGAME, CA, 94010
Administrator’s telephone number 8882283491

Signature of
Role Plan administrator
Date 2023-05-26
Name of individual signing CHRISTINE RIMER
INTEGRATED MEDICAL CLINIC LLC 401(K) PLAN 2021 821790890 2022-09-30 INTEGRATED MEDICAL CLINIC LLC 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-03-26
Business code 621111
Sponsor’s telephone number 2566221127
Plan sponsor’s address 510 S 4TH ST, GADSDEN, AL, 35901

Plan administrator’s name and address
Administrator’s EIN 474474775
Plan administrator’s name GUIDELINE, INC.
Plan administrator’s address 1645 E 6TH STREET, SUITE 200, AUSTIN, TX, 78702
Administrator’s telephone number 8882283491

Signature of
Role Plan administrator
Date 2022-09-29
Name of individual signing CHRISTINE RIMER
INTEGRATED MEDICAL CLINIC LLC 401(K) PLAN 2020 821790890 2021-07-16 INTEGRATED MEDICAL CLINIC LLC 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-03-26
Business code 621111
Sponsor’s telephone number 2566221127
Plan sponsor’s address 512 S 4TH ST, GADSDEN, AL, 35901

Plan administrator’s name and address
Administrator’s EIN 474474775
Plan administrator’s name GUIDELINE, INC.
Plan administrator’s address 3050 S DELAWARE ST, #202, SAN MATEO, CA, 94403
Administrator’s telephone number 8882283491

Signature of
Role Plan administrator
Date 2021-07-15
Name of individual signing CAROL HO
INTEGRATED MEDICAL CLINIC LLC 401(K) PLAN 2019 821790890 2020-07-03 INTEGRATED MEDICAL CLINIC LLC 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-03-26
Business code 621111
Sponsor’s telephone number 2566221127
Plan sponsor’s address 512 S 4TH ST, GADSDEN, AL, 35901

Plan administrator’s name and address
Administrator’s EIN 474474775
Plan administrator’s name GUIDELINE, INC.
Plan administrator’s address 3050 S DELAWARE ST, #202, SAN MATEO, CA, 94403
Administrator’s telephone number 8882283491

Signature of
Role Plan administrator
Date 2020-07-02
Name of individual signing CAROL HO
INTEGRATED MEDICAL CLINIC LLC 401(K) PLAN 2018 821790890 2019-07-24 INTEGRATED MEDICAL CLINIC LLC 6
Three-digit plan number (PN) 001
Effective date of plan 2018-03-26
Business code 621111
Sponsor’s telephone number 2566221127
Plan sponsor’s address 512 S 4TH ST, GADSDEN, AL, 35901

Plan administrator’s name and address
Administrator’s EIN 474474775
Plan administrator’s name GUIDELINE, INC.
Plan administrator’s address 3050 S DELAWARE ST, #202, SAN MATEO, CA, 94403
Administrator’s telephone number 8882283491

Signature of
Role Plan administrator
Date 2019-07-24
Name of individual signing CAROL HO
INTEGRATED MEDICAL CLINIC LLC 401(K) PLAN 2018 821790890 2020-05-18 INTEGRATED MEDICAL CLINIC LLC 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-03-26
Business code 621111
Sponsor’s telephone number 2566221127
Plan sponsor’s address 512 S 4TH ST, GADSDEN, AL, 35901

Plan administrator’s name and address
Administrator’s EIN 474474775
Plan administrator’s name GUIDELINE, INC.
Plan administrator’s address 3050 S DELAWARE ST, #202, SAN MATEO, CA, 94403
Administrator’s telephone number 8882283491

Signature of
Role Plan administrator
Date 2020-05-18
Name of individual signing CAROL HO

Agent

Name Role
UY, KARL PETER M Agent

Organizer

Name Role Address
WATSON, TRIPP Organizer 2829 2ND AVENUE SOUTH SUITE 220BIRMINGHAM, AL 35233

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WATSON, TRIPP

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Related by address

512 SOUTH 4TH STREETGADSDEN, AL 35901

James N. Wallace, M.D., P.A.

Date of last update: 13 Aug 2024

Sources: Alabama Secretary of State

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