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Southeastern Pain Management, LLC

Details

Name: Southeastern Pain Management, LLC
Jurisdiction: Alabama
Legal type: Domestic Limited Liability Company
Status: Exists
Date of registration: 02 Jan 2007 (18 years ago)
Entity Number: 000-488-375
Register Number: 000488375
County: Etowah
Place of Formation: Etowah County
Registered Office Street Address: 1026 GOODYEAR AVE BLDG 400 STE 302GADSDEN, AL 35903
Registered Office Street Address ZIP Code: 35903
Principal Address: GADSDEN, AL

Activities MEDICAL OFFICE

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1902974561 2006-12-01 2008-07-14 1026 GOODYEAR AVE, BLDG 400 STE 302, GADSDEN, AL, 359031102, US 1026 GOODYEAR AVE, BLDG 400 STE 302, GADSDEN, AL, 359031102, US

Contacts
Phone +1 256-492-7246
Fax 2564921168

Authorized person
Name MRS. MARY JACOBS-MURATTA
Role CHIEF OPERATING OFFICER
Phone 2564927246

Taxonomy
Taxonomy Code 174400000X - Specialist
Is Primary Yes

Other Provider Identifiers
Issuer BLUE CROSS BLUE SHIELD
Number 51521436
State AL
Issuer RAILROAD MEDICARE
Number P00145166
State AL
Issuer HEALTHSPRINGS OF ALABAMA
Number D97686
State AL
Issuer HUMANA GOLD
Number D97686
State AL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
SOUTHEASTERN PAIN MANAGEMENT, LLC 401(K) PROFIT SHARING PLAN 2013 721398641 2014-10-14 SOUTHEASTERN PAIN MANAGEMENT, LLC 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 2564927246
Plan sponsor’s address 1026 GOODYEAR AVENUE, BLDG. 400, SUITE 302, GADSDEN, AL, 35901

Signature of
Role Plan administrator
Date 2014-10-14
Name of individual signing PAUL MURATTA
SOUTHEASTERN PAIN MANAGEMENT, LLC 401(K) PROFIT SHARING PLAN 2012 721398641 2013-10-15 SOUTHEASTERN PAIN MANAGEMENT, LLC 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 2564927246
Plan sponsor’s address 1026 GOODYEAR AVENUE, BLDG. 400, SUITE 302, GADSDEN, AL, 35901

Signature of
Role Plan administrator
Date 2013-10-15
Name of individual signing PAUL MURATTA
SOUTHEASTERN PAIN MANAGEMENT, LLC 401(K) PROFIT SHARING PLAN 2011 721398641 2012-07-24 SOUTHEASTERN PAIN MANAGEMENT, LLC 19
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 2564927246
Plan sponsor’s address 1026 GOODYEAR AVENUE, BLDG. 400 STE, SUITE 302, GADSDEN, AL, 35901

Plan administrator’s name and address
Administrator’s EIN 721398641
Plan administrator’s name SOUTHEASTERN PAIN MANAGEMENT, LLC
Plan administrator’s address 1026 GOODYEAR AVENUE, BLDG. 400 STE, SUITE 302, GADSDEN, AL, 35901
Administrator’s telephone number 2564927246

Signature of
Role Plan administrator
Date 2012-07-24
Name of individual signing PAUL MURATTA
SOUTHEASTERN PAIN MANAGEMENT, LLC 401(K) PROFIT SHARING PLAN 2010 721398641 2011-10-12 SOUTHEASTERN PAIN MANAGEMENT, LLC 21
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 2564927246
Plan sponsor’s address 1026 GOODYEAR AVENUE, BLDG. 400, SUITE 302, GADSDEN, AL, 35901

Plan administrator’s name and address
Administrator’s EIN 721398641
Plan administrator’s name SOUTHEASTERN PAIN MANAGEMENT, LLC
Plan administrator’s address 1026 GOODYEAR AVENUE, BLDG. 400, SUITE 302, GADSDEN, AL, 35901
Administrator’s telephone number 2564927246

Signature of
Role Plan administrator
Date 2011-10-12
Name of individual signing PAUL MURATTA
SOUTHEASTERN PAIN MANAGEMENT, LLC 401(K) PROFIT SHARING PLAN 2009 721398641 2010-09-29 SOUTHEASTERN PAIN MANAGEMENT, LLC 20
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 2564927246
Plan sponsor’s address 1026 GOODYEAR AVENUE, BLDG. 400, SUITE 302, GADSDEN, AL, 35901

Plan administrator’s name and address
Administrator’s EIN 721398641
Plan administrator’s name SOUTHEASTERN PAIN MANAGEMENT, LLC
Plan administrator’s address 1026 GOODYEAR AVENUE, BLDG. 400, SUITE 302, GADSDEN, AL, 35901
Administrator’s telephone number 2564927246

Signature of
Role Plan administrator
Date 2010-09-29
Name of individual signing PAUL MURATTA

Member

Name Role Address
MURATTA, PAUL M Member 1026 GOODYEAR AVE BLDG 400 STE 302GADSDEN, AL 35903

Agent

Name Role Address
MURATTA, PAUL M Agent 1026 GOODYEAR AVE BLDG 400 STE 302GADSDEN, AL 35903

Related by officers

MURATTA, PAUL M

Muratta-Womble, Inc. Coastal States Management, P.C. Pain Specialists of Gadsden, Inc. Rising Phoenix Medi-Spa and Anti Aging Center, L.L.C.

Related by address

1026 GOODYEAR AVE BLDG 400 STE 302GADSDEN, AL 35903

Pain Specialists of Gadsden, Inc.

GADSDEN, AL

Wrenn Enterprises, Inc. A. & J. Manufacturing Co. Accounting Systems International, Inc. K.R.O., Inc. Adam Realty Corporation Adams Funeral Home, Inc. Adco Industries, Inc. Agricola Furnace Company, Inc. Alabama City Auto Parts, Incorporated Alabama Contractors Equipment, Inc.

Date of last update: 14 Aug 2024

Sources: Alabama Secretary of State

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