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Montgomery Otolaryngology, LLP

Details

Name: Montgomery Otolaryngology, LLP
Jurisdiction: Alabama
Legal type: Domestic Registered Limited Liability Partnership
Status: Dissolved
Date of registration: 10 Apr 2006 (19 years ago)
Date of dissolution: 29 Dec 2020
Entity Number: 000-401-345
Register Number: 000401345
County: Montgomery
Place of Formation: Montgomery County
Principal Address: 1111 OLIVE STREETMONTGOMERY, AL 36106
Principal Address ZIP Code: 36106

Activities ALL LAWFUL ACTIVITIES INCLUDING PRACTICE OF MEDICINE

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1497865893 2006-08-30 2011-04-12 1722 PINE ST, SUITE 804, MONTGOMERY, AL, 361061103, US 1722 PINE ST, SUITE 804, MONTGOMERY, AL, 361061103, US

Contacts
Phone +1 334-834-7221

Authorized person
Name MR. RODGER EGELAND
Role ADMINISTRATOR
Phone 3348347221

Taxonomy
Taxonomy Code 207Y00000X - Otolaryngology Physician
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 528801560
State AL
Issuer MEDICARE PTAN
Number D507
State AL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
MONTGOMERY OTOLARYNGOLOGY RETIREMENT PLAN 2019 630755234 2020-03-09 MONTGOMERY OTOLARYNGOLOGY 44
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1992-12-01
Business code 621111
Sponsor’s telephone number 3348347221
Plan sponsor’s address 1111 OLIVE STREET, MONTGOMERY, AL, 36106
MONTGOMERY OTOLARYNGOLOGY RETIREMENT PLAN 2018 630755234 2019-06-06 MONTGOMERY OTOLARYNGOLOGY 65
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1992-12-01
Business code 621111
Sponsor’s telephone number 3348347221
Plan sponsor’s address 1111 OLIVE STREET, MONTGOMERY, AL, 36106
MONTGOMERY OTOLARYNGOLOGY RETIREMENT PLAN 2017 630755234 2018-10-10 MONTGOMERY OTOLARYNGOLOGY 62
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1992-12-01
Business code 621111
Sponsor’s telephone number 3348347221
Plan sponsor’s address 1111 OLIVE STREET, MONTGOMERY, AL, 36106
MONTGOMERY OTOLARYNGOLOGY RETIREMENT PLAN 2016 630755234 2017-10-13 MONTGOMERY OTOLARYNGOLOGY 62
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1992-12-01
Business code 621111
Sponsor’s telephone number 3348347221
Plan sponsor’s address 1111 OLIVE STREET, MONTGOMERY, AL, 36106
MONTGOMERY OTOLARYNGOLOGY RETIREMENT PLAN 2015 630755234 2016-10-17 MONTGOMERY OTOLARYNGOLOGY 59
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1992-12-01
Business code 621111
Sponsor’s telephone number 3348347221
Plan sponsor’s address 1722 PINE STREET, SUITE 804, MONTGOMERY, AL, 36106
MONTGOMERY OTOLARYNGOLOGY RETIREMENT PLAN 2014 630755234 2016-10-17 MONTGOMERY OTOLARYNGOLOGY 56
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1992-12-01
Business code 621111
Sponsor’s telephone number 3348347221
Plan sponsor’s address 1722 PINE STREET, SUITE 804, MONTGOMERY, AL, 36106
MONTGOMERY OTOLARYNGOLOGY RETIREMENT PLAN 2014 630755234 2015-10-13 MONTGOMERY OTOLARYNGOLOGY 56
Three-digit plan number (PN) 001
Effective date of plan 1992-12-01
Business code 621111
Sponsor’s telephone number 3348347221
Plan sponsor’s address 1722 PINE STREET, SUITE 804, MONTGOMERY, AL, 36106
MONTGOMERY OTOLARYNGOLOGY RETIREMENT PLAN 2013 630755234 2014-10-14 MONTGOMERY OTOLARYNGOLOGY 53
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1992-12-01
Business code 621111
Sponsor’s telephone number 3348347221
Plan sponsor’s address 1722 PINE STREET, SUITE 804, MONTGOMERY, AL, 36106
MONTGOMERY OTOLARYNGOLOGY RETIREMENT PLAN 2012 630755234 2013-09-18 MONTGOMERY OTOLARYNGOLOGY 55
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1992-12-01
Business code 621111
Sponsor’s telephone number 3348347221
Plan sponsor’s address 1722 PINE STREET, SUITE 804, MONTGOMERY, AL, 36106

Signature of
Role Plan administrator
Date 2013-09-18
Name of individual signing GREGORY A. CLEMMONS
MONTGOMERY OTOLARYNGOLOGY RETIREMENT PLAN 2011 630755234 2012-10-16 MONTGOMERY OTOLARYNGOLOGY 50
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1992-12-01
Business code 621111
Sponsor’s telephone number 3348347221
Plan sponsor’s address 1722 PINE STREET, SUITE 804, MONTGOMERY, AL, 36106

Plan administrator’s name and address
Administrator’s EIN 630755234
Plan administrator’s name MONTGOMERY OTOLARYNGOLOGY
Plan administrator’s address 1722 PINE STREET, SUITE 804, MONTGOMERY, AL, 36106
Administrator’s telephone number 3348347221

Signature of
Role Plan administrator
Date 2012-10-15
Name of individual signing RODGER EGELAND

Agent

Name Role Address
BORG, GREGORY H Agent 1111 OLIVE STREETMONTGOMERY, AL 36106

Organizer

Name Role Address
BORG, GREGORY H Organizer 1111 OLIVE STREETMONTGOMERY, AL 36106

Related by officers

BORG, GREGORY H

Montgomery Hearing Services, LLC

Related by address

No related companies by address

Date of last update: 13 Aug 2024

Sources: Alabama Secretary of State

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