Clinic W, LLC

Details

Name:	Clinic W, LLC
Jurisdiction:	Alabama
Legal type:	Domestic Limited Liability Company
Status:	Exists
Date of registration:	31 Jul 2017 (7 years ago) (Companies founded in July 2017)
Entity Number:	000-397-915
Register Number:	000397915
ZIP code:	35209 (Companies in Jefferson, 35209)
County:	Jefferson
Place of Formation:	Jefferson County
Registered Office Street Address:	2200 WOODCREST PLACE, SUITE 310BIRMINGHAM, AL 35209

National Provider Identifier

NPI

Enumeration Date

Last Update Date

Mailing Address

Practice Location Address

1578087755

2017-07-31

2022-01-10

102 MEDICAL CENTER DR, CLANTON, AL, 350452332, US

102 MEDICAL CENTER DR, CLANTON, AL, 350452332, US

Contacts

Phone	+1 205-287-3900
Fax	8883004079
Phone	+1 205-383-5336

Authorized person

Name	DR. DAVID S. WILSON
Role	SOLE MEMBER
Phone	2053835336

Taxonomy

Taxonomy Code	207R00000X - Internal Medicine Physician
License Number	26067
State	AL
Is Primary	Yes
Taxonomy Code	207R00000X - Internal Medicine Physician
Is Primary	No

form 5500

Plan Name

Plan Year

EIN/PN

Received

Sponsor

Total number of participants

CLINIC W 401(K) PLAN

2023

822318193

2024-06-20

CLINIC W, LLC

6

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2019-01-01
Business code	621111
Sponsor’s telephone number	2052873900
Plan sponsor’s address	102 MEDICAL CENTER DR, CLANTON, AL, 35045

Signature of

Role	Plan administrator
Date	2024-06-06
Name of individual signing	HEATHER TURNER

CLINIC W 401(K) PLAN

2022

822318193

2023-05-22

CLINIC W, LLC

5

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2019-01-01
Business code	621111
Sponsor’s telephone number	2052873900
Plan sponsor’s address	102 MEDICAL CENTER DR, CLANTON, AL, 35045

Signature of

Role	Plan administrator
Date	2023-05-22
Name of individual signing	HEATHER TURNER

CLINIC W 401(K) PLAN

2021

822318193

2022-05-17

CLINIC W, LLC

4

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2019-01-01
Business code	621111
Sponsor’s telephone number	8883004079
Plan sponsor’s address	102 MEDICAL CENTER DR, CLANTON, AL, 35045

Signature of

Role	Plan administrator
Date	2022-05-17
Name of individual signing	HEATHER TURNER

CLINIC W 401(K) PLAN

2020

822318193

2021-07-20

CLINIC W, LLC

5

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2019-01-01
Business code	621111
Sponsor’s telephone number	8883004079
Plan sponsor’s address	102 MEDICAL CENTER DR, CLANTON, AL, 35045

Signature of

Role	Plan administrator
Date	2021-07-20
Name of individual signing	HEATHER TURNER

CLINIC W 401(K) PLAN

2019

822318193

2020-05-12

CLINIC W, LLC

4

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2019-01-01
Business code	621111
Sponsor’s telephone number	8883004079
Plan sponsor’s address	206 MEDICAL CENTER DRIVE, CLANTON, AL, 35045

Signature of

Role	Plan administrator
Date	2020-05-12
Name of individual signing	HEATHER TURNER

Role	Employer/plan sponsor
Date	2020-05-12
Name of individual signing	HEATHER TURNER

Agent

Name	Role	Address
WILSON, DAVID	Agent	239 MCLENDON ROADFT. MITCHELL, AL 36856

Organizer

Name	Role	Address
SCOTT, WALTER F III	Organizer	2200 WOODCREST PLACE, SUITE 310BIRMINGHAM, AL 35209

Date of last update: 13 Aug 2024

Sources: Alabama Secretary of State