Moonlight Diagnostics, LLC

Contacts

Phone	+1 334-416-8298
Fax	8332604473

Authorized person

Name	GREGORY R LIPSCOMB
Role	PRESIDENT
Phone	2515547798

Taxonomy

Taxonomy Code	2084N0400X - Neurology Physician
Is Primary	Yes

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2020-01-01
Business code	621111
Sponsor’s telephone number	3344168298
Plan sponsor’s address	3188 PARLIAMENT CIRCLE, SUITE 802, MONTGOMERY, AL, 36116

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2020-01-01
Business code	621111
Sponsor’s telephone number	3344168298
Plan sponsor’s address	3188 PARLIAMENT CIRCLE, SUITE 802, MONTGOMERY, AL, 36116

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2020-01-01
Business code	621111
Sponsor’s telephone number	3344168298
Plan sponsor’s address	3188 PARLIAMENT CIRCLE, SUITE 802, MONTGOMERY, AL, 36116

File	View Page
Three-digit plan number (PN)	501
Effective date of plan	2019-04-01
Business code	524140
Sponsor’s telephone number	3344168298
Plan sponsor’s address	3188 PARLIAMENT CIRCLE, SUITE 802, MONTGOMERY, AL, 36116

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 STE 200, MONTGOMERY, AL, 36116
Administrator’s telephone number	3342607774

Signature of

Role	Plan administrator
Date	2021-10-06
Name of individual signing	THOMAS BRITT TAYLOR

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2020-01-01
Business code	621111
Sponsor’s telephone number	3344168298
Plan sponsor’s address	3188 PARLIAMENT CIRCLE, SUITE 802, MONTGOMERY, AL, 36116

File	View Page
Three-digit plan number (PN)	501
Effective date of plan	2019-04-01
Business code	524140
Sponsor’s telephone number	3344168298
Plan sponsor’s address	3188 PARLIAMENT CIRCLE, SUITE 802, MONTGOMERY, AL, 36116

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 STE 200, MONTGOMERY, AL, 36116
Administrator’s telephone number	3342607774

Signature of

Role	Plan administrator
Date	2020-10-14
Name of individual signing	THOMAS BRITT TAYLOR