| Name: | Springville Pediatrics, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 29 Aug 2017 (7 years ago) (Companies founded in August 2017) |
| Entity Number: | 000-402-197 |
| Register Number: | 000402197 |
| ZIP code: | 35146 (Companies in Saint Clair, 35146) |
| County: | Saint Clair |
| Place of Formation: | Saint Clair County |
| Registered Office Street Address: | 350 SPRINGVILLE STATION BLVDSPRINGVILLE, AL 35146 |
| Unique Entity ID | Expiration Date | Physical Address | Mailing Address | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| TM9NTUP5Z2M6 | 2023-07-15 | 350 SPRINGVILLE STA, SPRINGVILLE, AL, 35146, USA | 350 SPRINGVILLE STA, SPRINGVILLE, AL, 35146, 6163, USA | |||||||||||||||||||||||||||||||||||||||||
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| URL | springvillepediatric.com |
| Congressional District | 03 |
| State/Country of Incorporation | AL, USA |
| Activation Date | 2022-07-19 |
| Initial Registration Date | 2021-06-08 |
| Entity Start Date | 2017-08-29 |
| Fiscal Year End Close Date | Dec 31 |
Points of Contacts
| Electronic Business | |
|---|---|
| Title | PRIMARY POC |
| Name | CHARLES P ROSE |
| Role | CFO |
| Address | 1359 OLD WATERWORKS RD SW, FORT PAYNE, AL, 35968, 3347, USA |
| Government Business | |
|---|---|
| Title | PRIMARY POC |
| Name | CHARLES P ROSE |
| Role | CFO |
| Address | 1359 OLD WATERWORKS RD SW, FORT PAYNE, AL, 35968, 3347, USA |
| Past Performance | Information not Available |
|---|
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1689187080 | 2017-11-08 | 2020-05-07 | 350 SPRINGVILLE STA, SPRINGVILLE, AL, 351466163, US | 350 SPRINGVILLE STATION BLVD, SPRINGVILLE, AL, 35146, US | |||||||||||||||||||||||||||||
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| Phone | +1 256-490-0361 |
Authorized person
| Name | MRS. MONICA CHADWICK |
| Role | OWNER |
| Phone | 2564900361 |
Taxonomy
| Taxonomy Code | 208000000X - Pediatrics Physician |
| Is Primary | Yes |
| Taxonomy Code | 261QR1300X - Rural Health Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 363L00000X - Nurse Practitioner |
| Is Primary | No |
| Taxonomy Code | 363LF0000X - Family Nurse Practitioner |
| Is Primary | No |
| Taxonomy Code | 363LP0200X - Pediatric Nurse Practitioner |
| Is Primary | No |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SPRINGVILLE PEDIATRICS, LLC (WELFARE PLAN) | 2022 | 822636964 | 2023-07-27 | SPRINGVILLE PEDIATRICS, LLC | 6 | |||||||||||||||||||||||||||||||||||||
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| Administrator’s EIN | 472506773 |
| Plan administrator’s name | KENNION & CO, LLC |
| Plan administrator’s address | 2828 OLD 280 COURT, SUITE 110, VESTAVIA, AL, 35243 |
| Administrator’s telephone number | 8669665457 |
Signature of
| Role | Plan administrator |
| Date | 2023-07-20 |
| Name of individual signing | W. HAL SHEPHERD |
| Role | Employer/plan sponsor |
| Date | 2023-07-20 |
| Name of individual signing | W. HAL SHEPHERD |
| File | View Page |
| Three-digit plan number (PN) | 951 |
| Effective date of plan | 2020-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 2057732075 |
| Plan sponsor’s address | 350 SPRINGVILLE STATION, SPRINGVILLE, AL, 35146 |
Plan administrator’s name and address
| Administrator’s EIN | 472506773 |
| Plan administrator’s name | KENNION & CO, LLC |
| Plan administrator’s address | 2828 OLD 280 COURT, SUITE 110, VESTAVIA, AL, 35243 |
| Administrator’s telephone number | 8669665457 |
Signature of
| Role | Plan administrator |
| Date | 2022-07-20 |
| Name of individual signing | W. HAL SHEPHERD |
| Role | Employer/plan sponsor |
| Date | 2022-07-20 |
| Name of individual signing | W. HAL SHEPHERD |
| File | View Page |
| Three-digit plan number (PN) | 951 |
| Effective date of plan | 2020-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 2057732075 |
| Plan sponsor’s address | 350 SPRINGVILLE STATION, SPRINGVILLE, AL, 35146 |
Plan administrator’s name and address
| Administrator’s EIN | 472506773 |
| Plan administrator’s name | KENNION & CO, LLC |
| Plan administrator’s address | 2828 OLD 280 COURT, SUITE 110, VESTAVIA, AL, 35243 |
| Administrator’s telephone number | 8669665457 |
Signature of
| Role | Plan administrator |
| Date | 2021-07-21 |
| Name of individual signing | W. HAL SHEPHERD |
| Role | Employer/plan sponsor |
| Date | 2021-07-21 |
| Name of individual signing | W. HAL SHEPHERD |
| Name | Role |
|---|---|
| CHADWICK, MONICA M | Agent |
Date of last update: 13 Aug 2024
Sources: Alabama Secretary of State
