| Name: | Alabama Surgical Arts, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 29 Dec 2017 (7 years ago) |
| Entity Number: | 000-505-509 |
| Register Number: | 000505509 |
| County: | Montgomery |
| Place of Formation: | Jefferson County |
| Registered Office Street Address: | 4590 WOODMERE BLVDMONTGOMERY, AL 36106 |
| Registered Office Street Address ZIP Code: | 36106 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1871085415 | 2018-05-30 | 2018-12-12 | 4590 WOODMERE BLVD, MONTGOMERY, AL, 361062918, US | 4590 WOODMERE BLVD, MONTGOMERY, AL, 361062918, US | |||||||||||||||||||||||||
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| Phone | +1 334-271-2002 |
| Phone | +1 334-271-4523 |
| Fax | 3342712002 |
Authorized person
| Name | DR. SAMI ADAM NIZAM II |
| Role | MANAGER |
| Phone | 3342712002 |
Taxonomy
| Taxonomy Code | 1223S0112X - Oral and Maxillofacial Surgery (Dentist) |
| Is Primary | Yes |
| Taxonomy Code | 204E00000X - Oral & Maxillofacial Surgery (D.M.D.) |
| Is Primary | No |
| Taxonomy Code | 363A00000X - Physician Assistant |
| Is Primary | No |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ALABAMA SURGICAL ARTS 401(K) PLAN | 2023 | 824404243 | 2024-03-18 | ALABAMA SURGICAL ARTS, LLC | 20 | |||||||||||||||||||||||||||||
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| ALABAMA SURGICAL ARTS 401(K) PLAN | 2022 | 824404243 | 2023-06-28 | ALABAMA SURGICAL ARTS | 17 | |||||||||||||||||||||||||||||
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| ALABAMA SURGICAL ARTS 401(K) PLAN | 2021 | 824404243 | 2022-09-25 | ALABAMA SURGICAL ARTS | 11 | |||||||||||||||||||||||||||||
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| ALABAMA SURGICAL ARTS 401(K) PLAN | 2020 | 824404243 | 2021-05-12 | ALABAMA SURGICAL ARTS | 8 | |||||||||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2021-05-12 |
| Name of individual signing | SAMI NIZAM |
| Role | Employer/plan sponsor |
| Date | 2021-05-12 |
| Name of individual signing | SAMI NIZAM |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2018-10-01 |
| Business code | 621210 |
| Sponsor’s telephone number | 3342712002 |
| Plan sponsor’s address | 4590 WOODMERE BLVD, MONTGOMERY, AL, 361062918 |
Signature of
| Role | Plan administrator |
| Date | 2020-05-22 |
| Name of individual signing | SAMI NIZAM |
| Role | Employer/plan sponsor |
| Date | 2020-05-22 |
| Name of individual signing | SAMI NIZAM |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2018-10-01 |
| Business code | 621210 |
| Sponsor’s telephone number | 3342712002 |
| Plan sponsor’s address | 4590 WOODMERE BLVD, MONTGOMERY, AL, 361062918 |
Signature of
| Role | Plan administrator |
| Date | 2019-05-08 |
| Name of individual signing | SAMI NIZAM |
| Role | Employer/plan sponsor |
| Date | 2019-05-08 |
| Name of individual signing | SAMI NIZAM |
| Name | Role |
|---|---|
| NIZAM, SAMI II | Agent |
| Name | Role | Address |
|---|---|---|
| LEGALZOOM.COM INC | Organizer | 101 N BRAND BLVD 10TH FLOORGLENDALE, CA 91203 |
Date of last update: 14 Aug 2024
Sources: Alabama Secretary of State
