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Boltz Pain Center, LLC

Details

Name: Boltz Pain Center, LLC
Jurisdiction: Alabama
Legal type: Domestic Limited Liability Company
Status: Exists
Date of registration: 01 Oct 2008 (16 years ago)
Entity Number: 000-425-934
Register Number: 000425934
County: Baldwin
Place of Formation: Baldwin County
Principal Address: DAPHNE, AL
Registered Office Street Address: ONE TIMBER WAY STE 203DAPHNE, AL 36527
Registered Office Street Address ZIP Code: 36527

Activities MEDICAL PRACTICE

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1235381013 2008-10-12 2008-10-12 1 TIMBER WAY, SUITE 203, SPANISH FORT, AL, 365275682, US 1 TIMBER WAY, SUITE 203, SPANISH FORT, AL, 365275682, US

Contacts
Phone +1 251-626-9544

Authorized person
Name PATRICIA A. BOLTZ
Role PRESIDENT
Phone 2516269544

Taxonomy
Taxonomy Code 207LP2900X - Pain Medicine (Anesthesiology) Physician
License Number MD.21886
State AL
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
BOLTZ PAIN CENTER RETIREMENT TRUST 2020 263478129 2021-10-12 BOLTZ PAIN CENTER 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-02-01
Business code 621111
Sponsor’s telephone number 2514457225
Plan sponsor’s address 1 TIMBER WAY, STE. 203, SPANISH FORT, AL, 36527

Signature of
Role Plan administrator
Date 2021-10-12
Name of individual signing PATRICIA BOLTZ
BOLTZ PAIN CENTER RETIREMENT TRUST 2019 263478129 2021-01-14 BOLTZ PAIN CENTER 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-02-01
Business code 621111
Sponsor’s telephone number 2514457225
Plan sponsor’s address 1 TIMBER WAY, STE. 203, SPANISH FORT, AL, 36527

Signature of
Role Plan administrator
Date 2021-01-14
Name of individual signing PATRICIA BOLTZ
BOLTZ PAIN CENTER RETIREMENT TRUST 2018 263478129 2019-10-14 BOLTZ PAIN CENTER 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-02-01
Business code 621111
Sponsor’s telephone number 2514457225
Plan sponsor’s address 1 TIMBER WAY, STE. 203, SPANISH FORT, AL, 36527

Signature of
Role Plan administrator
Date 2019-10-14
Name of individual signing PATRICIA BOLTZ
BOLTZ PAIN CENTER RETIREMENT TRUST 2017 263478129 2018-10-15 BOLTZ PAIN CENTER 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-02-01
Business code 621111
Sponsor’s telephone number 2514457225
Plan sponsor’s address 1 TIMBER WAY, STE. 203, SPANISH FORT, AL, 36527

Signature of
Role Plan administrator
Date 2018-10-15
Name of individual signing PATRICIA BOLTZ
BOLTZ PAIN CENTER RETIREMENT TRUST 2016 263478129 2017-06-02 BOLTZ PAIN CENTER 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-02-01
Business code 621111
Sponsor’s telephone number 2514457225
Plan sponsor’s address 1 TIMBER WAY, STE. 203, SPANISH FORT, AL, 36527

Signature of
Role Plan administrator
Date 2017-06-02
Name of individual signing PATRICIA BOLTZ
BOLTZ PAIN CENTER RETIREMENT TRUST 2015 263478129 2016-05-02 BOLTZ PAIN CENTER 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-02-01
Business code 621111
Sponsor’s telephone number 2514457225
Plan sponsor’s address 1 TIMBER WAY, SUITE 203, SPANISH FORT, AL, 36527

Signature of
Role Plan administrator
Date 2016-05-02
Name of individual signing PATRICIA BOLTZ
BOLTZ PAIN CENTER RETIREMENT TRUST 2014 263478129 2015-09-01 BOLTZ PAIN CENTER 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-02-01
Business code 621111
Sponsor’s telephone number 2514457225
Plan sponsor’s address 1 TIMBER WAY, SUITE 203, SPANISH FORT, AL, 36527

Signature of
Role Plan administrator
Date 2015-09-01
Name of individual signing JAMES CURRAN
BOLTZ PAIN CENTER RETIREMENT TRUST 2013 263478129 2014-06-13 BOLTZ PAIN CENTER 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-02-01
Business code 621111
Sponsor’s telephone number 2514457225
Plan sponsor’s address 1 TIMBER WAY, SUITE 203, SPANISH FORT, AL, 36527

Signature of
Role Plan administrator
Date 2014-06-13
Name of individual signing JAMES CURRAN
Role Employer/plan sponsor
Date 2014-06-13
Name of individual signing JAMES CURRAN
BOLTZ PAIN CENTER RETIREMENT TRUST 2012 263478129 2013-07-17 BOLTZ PAIN CENTER 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-02-01
Business code 621111
Sponsor’s telephone number 2514457225
Plan sponsor’s address 1 TIMBER WAY, SUITE 203, SPANISH FORT, AL, 36527

Signature of
Role Plan administrator
Date 2013-07-17
Name of individual signing JAMES CURRAN
Role Employer/plan sponsor
Date 2013-07-17
Name of individual signing JAMES CURRAN
BOLTZ PAIN CENTER RETIREMENT TRUST 2011 263478129 2012-05-02 BOLTZ PAIN CENTER 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-02-01
Business code 621111
Sponsor’s telephone number 2514457225
Plan sponsor’s address 1 TIMBER WAY, SUITE 203, SPANISH FORT, AL, 36527

Plan administrator’s name and address
Administrator’s EIN 263478129
Plan administrator’s name BOLTZ PAIN CENTER
Plan administrator’s address 1 TIMBER WAY, SUITE 203, SPANISH FORT, AL, 36527
Administrator’s telephone number 2514457225

Signature of
Role Plan administrator
Date 2012-05-02
Name of individual signing JAMES CURRAN

Agent

Name Role
BOLTZ, MARK T Agent

Member

Name Role
BOLTZ, PATRICIA A Member

Related by officers

BOLTZ, MARK T

BPC Land, LLC

BOLTZ, PATRICIA A

BPC Land, LLC

Related by address

DAPHNE, AL

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ONE TIMBER WAY STE 203DAPHNE, AL 36527

Staff Smart, Inc. BPC Land, LLC

Date of last update: 13 Aug 2024

Sources: Alabama Secretary of State

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