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East Montgomery Christian Family Medicine, LLC

Details

Name: East Montgomery Christian Family Medicine, LLC
Jurisdiction: Alabama
Legal type: Domestic Limited Liability Company
Status: Exists
Date of registration: 24 Feb 2005 (20 years ago)
Entity Number: 000-460-859
Register Number: 000460859
County: Montgomery
Place of Formation: Montgomery County
Principal Address: MONTGOMERY, AL
Registered Office Street Address: 9201 ALLENWOOD COURTMONTGOMERY, AL 36117
Registered Office Street Address ZIP Code: 36117

Activities PRACTICE OF MEDICINE

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1174631766 2006-08-25 2017-02-09 129 MITYLENE PARK LN, MONTGOMERY, AL, 361177302, US 129 MITYLENE PARK LN, MONTGOMERY, AL, 361177302, US

Contacts
Phone +1 334-279-8180
Fax 3342798214

Authorized person
Name DR. ASHLEY D MCINTYRE
Role OWNER
Phone 3342798180

Taxonomy
Taxonomy Code 208D00000X - General Practice Physician
License Number 00025985
State AL
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 009991115
State AL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
EAST MONTGOMERY CHRISTIAN FAMILY MEDICINE PENSION PLAN 2020 260107894 2021-10-12 EAST MONTGOMERY CHRISTIAN FAMILY MEDICINE 11
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 3342798180
Plan sponsor’s address 129 MITYLENE PARK LANE, MONTGOMERY, AL, 361177104

Plan administrator’s name and address
Administrator’s EIN 260107894
Plan administrator’s name EAST MONTGOMERY CHRISTIAN FAMILY MEDICINE
Plan administrator’s address 129 MITYLENE PARK LANE, MONTGOMERY, AL, 361177104
Administrator’s telephone number 3342798180
EAST MONTGOMERY CHRISTIAN FAMILY MEDICINE 401(K) PLAN 2020 260107894 2021-10-12 EAST MONTGOMERY CHRISTIAN FAMILY MEDICINE 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 3342798180
Plan sponsor’s address 129 MITYLENE PARK LANE, MONTGOMERY, AL, 361177104

Plan administrator’s name and address
Administrator’s EIN 260107894
Plan administrator’s name EAST MONTGOMERY CHRISTIAN FAMILY MEDICINE
Plan administrator’s address 129 MITYLENE PARK LANE, MONTGOMERY, AL, 361177104
Administrator’s telephone number 3342798180
EAST MONTGOMERY CHRISTIAN FAMILY MEDICINE PENSION PLAN 2019 260107894 2020-10-15 EAST MONTGOMERY CHRISTIAN FAMILY MEDICINE 11
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 3342798180
Plan sponsor’s address 129 MITYLENE PARK LANE, MONTGOMERY, AL, 361177104

Plan administrator’s name and address
Administrator’s EIN 260107894
Plan administrator’s name EAST MONTGOMERY CHRISTIAN FAMILY MEDICINE
Plan administrator’s address 129 MITYLENE PARK LANE, MONTGOMERY, AL, 361177104
Administrator’s telephone number 3342798180
EAST MONTGOMERY CHRISTIAN FAMILY MEDICINE 401(K) PLAN 2019 260107894 2020-10-15 EAST MONTGOMERY CHRISTIAN FAMILY MEDICINE 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 3342798180
Plan sponsor’s address 129 MITYLENE PARK LANE, MONTGOMERY, AL, 361177104

Plan administrator’s name and address
Administrator’s EIN 260107894
Plan administrator’s name EAST MONTGOMERY CHRISTIAN FAMILY MEDICINE
Plan administrator’s address 129 MITYLENE PARK LANE, MONTGOMERY, AL, 361177104
Administrator’s telephone number 3342798180
EAST MONTGOMERY CHRISTIAN FAMILY MEDICINE 401(K) PLAN 2018 260107894 2019-10-15 EAST MONTGOMERY CHRISTIAN FAMILY MEDICINE 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 3342798180
Plan sponsor’s address 129 MITYLENE PARK LANE, MONTGOMERY, AL, 361177104

Plan administrator’s name and address
Administrator’s EIN 260107894
Plan administrator’s name EAST MONTGOMERY CHRISTIAN FAMILY MEDICINE
Plan administrator’s address 129 MITYLENE PARK LANE, MONTGOMERY, AL, 361177104
Administrator’s telephone number 3342798180
EAST MONTGOMERY CHRISTIAN FAMILY MEDICINE PENSION PLAN 2018 260107894 2019-10-15 EAST MONTGOMERY CHRISTIAN FAMILY MEDICINE 11
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 3342798180
Plan sponsor’s address 129 MITYLENE PARK LANE, MONTGOMERY, AL, 361177104

Plan administrator’s name and address
Administrator’s EIN 260107894
Plan administrator’s name EAST MONTGOMERY CHRISTIAN FAMILY MEDICINE
Plan administrator’s address 129 MITYLENE PARK LANE, MONTGOMERY, AL, 361177104
Administrator’s telephone number 3342798180
EAST MONTGOMERY CHRISTIAN FAMILY MEDICINE 401(K) PLAN 2017 260107894 2018-10-11 EAST MONTGOMERY CHRISTIAN FAMILY MEDICINE 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 3342798180
Plan sponsor’s address 129 MITYLENE PARK LANE, MONTGOMERY, AL, 361177104

Plan administrator’s name and address
Administrator’s EIN 260107894
Plan administrator’s name EAST MONTGOMERY CHRISTIAN FAMILY MEDICINE
Plan administrator’s address 129 MITYLENE PARK LANE, MONTGOMERY, AL, 361177104
Administrator’s telephone number 3342798180
EAST MONTGOMERY CHRISTIAN FAMILY MEDICINE PENSION PLAN 2017 260107894 2018-10-11 EAST MONTGOMERY CHRISTIAN FAMILY MEDICINE 7
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 3342798180
Plan sponsor’s address 129 MITYLENE PARK LANE, MONTGOMERY, AL, 361177104

Plan administrator’s name and address
Administrator’s EIN 260107894
Plan administrator’s name EAST MONTGOMERY CHRISTIAN FAMILY MEDICINE
Plan administrator’s address 129 MITYLENE PARK LANE, MONTGOMERY, AL, 361177104
Administrator’s telephone number 3342798180
EAST MONTGOMERY CHRISTIAN FAMILY MEDICINE 401(K) PLAN 2016 260107894 2017-10-16 EAST MONTGOMERY CHRISTIAN FAMILY MEDICINE 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 3342798180
Plan sponsor’s address 128 MITYLENE PARK LANE, MONTGOMERY, AL, 361177104

Plan administrator’s name and address
Administrator’s EIN 260107894
Plan administrator’s name EAST MONTGOMERY CHRISTIAN FAMILY MEDICINE
Plan administrator’s address 416 ST. LUKES DRIVE, SUITE A, MONTGOMERY, AL, 361177104
Administrator’s telephone number 3342798180
EAST MONTGOMERY CHRISTIAN FAMILY MEDICINE PENSION PLAN 2016 260107894 2017-10-16 EAST MONTGOMERY CHRISTIAN FAMILY MEDICINE 5
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 3342798180
Plan sponsor’s address 128 MITYLENE PARK LANE, MONTGOMERY, AL, 361177104

Plan administrator’s name and address
Administrator’s EIN 260107894
Plan administrator’s name EAST MONTGOMERY CHRISTIAN FAMILY MEDICINE
Plan administrator’s address 416 ST. LUKES DRIVE, SUITE A, MONTGOMERY, AL, 361177104
Administrator’s telephone number 3342798180

Agent

Name Role Address
MCINTYRE, ASHLEY Agent 2126 SIXTH AVE SE SUITE 201DECATUR, AL 35601

Member

Name Role Address
MCINTYRE, ASHLEY Member 2126 SIXTH AVE SE SUITE 201DECATUR, AL 35601

Related by officers

MCINTYRE, ASHLEY

FIRST CARE 1 LLC boostmale.com, LLC Diversified Restaurant Management and Investment Group, LLC River Region Eldercare Solutions, LLC Prattville Christian Family Medicine, LLC Mitylene Park Medical Complex LLC The McIntyre Agency, LLC FADM Properties, LLC Beat Docs, L.L.C.

Related by address

MONTGOMERY, AL

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Date of last update: 14 Aug 2024

Sources: Alabama Secretary of State

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