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Primary Care Services-Blount LLC

Details

Name: Primary Care Services-Blount LLC
Jurisdiction: Alabama
Legal type: Domestic Limited Liability Company
Status: Exists
Date of registration: 07 Jul 2006 (18 years ago)
Entity Number: 000-481-385
Register Number: 000481385
County: Jefferson
Place of Formation: Jefferson County
Principal Address: TRUSSVILLE, AL
Registered Office Street Address: 353 BRENTWOOD AVETRUSSVILLE, AL 35173
Registered Office Street Address ZIP Code: 35173

Activities DELIVER MEDICAL SERVICES

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1225108723 2006-11-09 2018-11-05 PO BOX 389, CLAY, AL, 350480389, US 101 LEMLEY DR STE A, ONEONTA, AL, 351212100, US

Contacts
Phone +1 205-625-3561
Fax 2052749638

Authorized person
Name DR. ZAKIR N KHAN
Role OWNER
Phone 2056253561

Taxonomy
Taxonomy Code 207Q00000X - Family Medicine Physician
Is Primary No
Taxonomy Code 207R00000X - Internal Medicine Physician
License Number 22909
State AL
Is Primary No
Taxonomy Code 261QP2300X - Primary Care Clinic/Center
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
PRIMARY CARE SERVICES 401(K) PLAN 2023 205134447 2024-06-07 PRIMARY CARE SERVICES - BLOUNT LLC 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 2056253561
Plan sponsor’s address 5299 KIRBY LANE, TRUSSVILLE, AL, 35173

Signature of
Role Plan administrator
Date 2024-06-07
Name of individual signing ZAKIR KHAN
PRIMARY CARE SERVICES 401(K) PLAN 2022 205134447 2023-07-12 PRIMARY CARE SERVICES - BLOUNT LLC 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 2056253561
Plan sponsor’s address 5299 KIRBY LANE, TRUSSVILLE, AL, 35173

Signature of
Role Plan administrator
Date 2023-07-12
Name of individual signing ZAKIR KHAN
PRIMARY CARE SERVICES 401(K) PLAN 2021 205134447 2022-07-12 PRIMARY CARE SERVICES - BLOUNT LLC 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 2056253561
Plan sponsor’s address 5920 DEER CREST LANE, TRUSSVILLE, AL, 35173

Signature of
Role Plan administrator
Date 2022-07-12
Name of individual signing ZAKIR KHAN
PRIMARY CARE SERVICES BLOUNT HEALTH AND WELFARE BENEFIT PLAN 2020 205134447 2021-10-11 PRIMARY CARE SERVICES BLOUNT 4
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2020-12-01
Business code 524140
Sponsor’s telephone number 2056253561
Plan sponsor’s address 101 LEMLEY DRIVE SUITE A, ONEONTA, AL, 35121

Plan administrator’s name and address
Administrator’s EIN 834125247
Plan administrator’s name ARSENAL HEALTH LLC
Plan administrator’s address 5151 HAMPSTEAD HIGH STREET, SUITE 200, MONTGOMERY, AL, 36116

Signature of
Role Plan administrator
Date 2021-10-07
Name of individual signing THOMAS BRITT TAYLOR
PRIMARY CARE SERVICES 401(K) PLAN 2020 205134447 2021-06-14 PRIMARY CARE SERVICES - BLOUNT LLC 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 2056253561
Plan sponsor’s address 5920 DEER CREST LANE, TRUSSVILLE, AL, 35173

Signature of
Role Plan administrator
Date 2021-06-14
Name of individual signing ZAKIR KHAN
PRIMARY CARE SERVICES 401(K) PLAN 2019 205134447 2020-05-01 PRIMARY CARE SERVICES - BLOUNT LLC 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 2056253561
Plan sponsor’s address 5920 DEER CREST LANE, TRUSSVILLE, AL, 35173

Signature of
Role Plan administrator
Date 2020-05-01
Name of individual signing ZAKIR KHAN
PRIMARY CARE SERVICES 401(K) PLAN 2018 205134447 2019-07-02 PRIMARY CARE SERVICES - BLOUNT LLC 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 2056253561
Plan sponsor’s address 5920 DEER CREST LANE, TRUSSVILLE, AL, 35173

Signature of
Role Plan administrator
Date 2019-07-02
Name of individual signing ZAKIR KHAN
PRIMARY CARE SERVICES 401(K) PLAN 2017 205134447 2018-06-20 PRIMARY CARE SERVICES - BLOUNT LLC 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 2056253561
Plan sponsor’s address 5920 DEER CREST LANE, TRUSSVILLE, AL, 35173

Signature of
Role Plan administrator
Date 2018-06-20
Name of individual signing ZAKIR KHAN
PRIMARY CARE SERVICES 401(K) PLAN 2016 205134447 2017-05-19 PRIMARY CARE SERVICES - BLOUNT LLC 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 2056253561
Plan sponsor’s address 5920 DEER CREST LANE, TRUSSVILLE, AL, 35173

Signature of
Role Plan administrator
Date 2017-05-19
Name of individual signing ZAKIR KHAN
PRIMARY CARE SERVICES 401(K) PLAN 2015 205134447 2016-07-12 PRIMARY CARE SERVICES - BLOUNT LLC 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 2056253561
Plan sponsor’s address 5920 DEER CREST LANE, TRUSSVILLE, AL, 35173

Agent

Name Role
KHAN, ZAKIR Agent

Member

Name Role
KHAN, ZAKIR Member
KHAN, MINA Member

Related by officers

KHAN, ZAKIR

Property Management Services - Blount, LLC

KHAN, MINA

Property Management Services - Blount, LLC

Related by address

TRUSSVILLE, AL

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353 BRENTWOOD AVETRUSSVILLE, AL 35173

Property Management Services - Blount, LLC

Date of last update: 14 Aug 2024

Sources: Alabama Secretary of State

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