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Bayouclinic, Inc.

Details

Name: Bayouclinic, Inc.
Jurisdiction: Alabama
Legal type: Domestic Non-Profit Corporation
Status: Exists
Date of registration: 29 Mar 2001 (24 years ago) (Companies founded in March 2001)
Entity Number: 000-554-398
Register Number: 000554398
ZIP code: 36509 (Companies in Mobile, 36509)
County: Mobile
Place of Formation: Mobile County
Principal Address: BAYOU LA BATRE, AL
Registered Office Mailing Address: 318 PATRICIAN DRIVESPANISH FORT, AL 36527
Registered Office Street Address: 13220 WINTZELL AVENUEBAYOU LA BATRE, AL 36509

Activities SUPPORT THE OPERATIONS OF MEDICAL CLINICS

Unique Entity ID

Unique Entity ID Expiration Date Physical Address Mailing Address
MSLPT9LVSN86 2025-01-18 13220 N WINTZELL AVE, BAYOU LA BATRE, AL, 36509, 2142, USA 13220 N WINTZELL AVE, BAYOU LA BATRE, AL, 36509, 2142, USA

Business Information
URL http://www.bayouclinic.org
Congressional District 01
State/Country of Incorporation AL, USA
Activation Date 2024-01-23
Initial Registration Date 2004-04-05
Entity Start Date 2001-04-01
Fiscal Year End Close Date Dec 31

Service Classifications
NAICS Codes 621111

Points of Contacts
Electronic Business
Title PRIMARY POC
Name JULIE TAYLOR
Role EXECUTIVE DIRECTOR
Address 13220 WINTZELL AVE, BAYOU LA BATRE, AL, 36509, 2515, USA
Title ALTERNATE POC
Name JULIE TAYLOR
Address 13833 TAPIA LANE, BAYOU LA BATRE, AL, 36509, USA
Government Business
Title PRIMARY POC
Name REGINA BENJAMIN
Role BOARD PRESIDENT
Address 13220 WINTZELL AVE, BAYOU LA BATRE, AL, 36509, 2515, USA
Title ALTERNATE POC
Name J TAYLOR
Address 13833 TAPIA LANE, BAYOU LA BATRE, AL, 36509, USA
Past Performance Information not Available

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1114996865 2006-03-15 2022-10-14 13220 N WINTZELL AVE, BAYOU LA BATRE, AL, 365092142, US 13833 TAPIA AVE, BAYOU LA BATRE, AL, 365092515, US

Contacts
Phone +1 251-824-4985
Fax 2518244990

Authorized person
Name JULIE H TAYLOR
Role INTERIM EXECUTIVE DIRECTOR
Phone 2518244985

Taxonomy
Taxonomy Code 207Q00000X - Family Medicine Physician
State AL
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 529932897
State AL
Issuer MEDICAID
Number 541003845
State AL

Commercial and government entity program

CAGE number Status Type Established CAGE Update Date CAGE Expiration SAM Expiration
3TLP3 Active Non-Manufacturer 2004-04-05 2024-01-23 2029-01-23 2025-01-18

Contact Information
POC REGINA BENJAMIN
Phone +1 251-824-4985
Fax +1 251-824-4990
Address 13220 N WINTZELL AVE, BAYOU LA BATRE, AL, 36509 2142, UNITED STATES

Ownership of Offeror Information
Highest Level Owner Information not Available
Immediate Level Owner Information not Available
List of Offerors (0) Information not Available

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
BAYOUCLINIC 401(K) PLAN 2023 631270951 2024-08-01 BAYOUCLINIC, INC. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-11-01
Business code 621111
Sponsor’s telephone number 2518244985
Plan sponsor’s address 13220 WINTZELL AVE., BAYOU LA BATRE, AL, 36509
BAYOUCLINIC 401(K) PLAN 2022 631270951 2023-10-11 BAYOUCLINIC, INC. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-11-01
Business code 621111
Sponsor’s telephone number 2518244985
Plan sponsor’s address 13220 WINTZELL AVE., BAYOU LA BATRE, AL, 36509
BAYOUCLINIC 401(K) PLAN 2021 631270951 2022-10-10 BAYOUCLINIC, INC. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-11-01
Business code 621111
Sponsor’s telephone number 2518244985
Plan sponsor’s address 13220 WINTZELL AVE., BAYOU LA BATRE, AL, 36509
BAYOUCLINIC 401(K) PLAN 2020 631270951 2021-05-27 BAYOUCLINIC, INC. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-11-01
Business code 621111
Sponsor’s telephone number 2518244985
Plan sponsor’s address 13220 WINTZELL AVE., BAYOU LA BATRE, AL, 36509
BAYOUCLINIC 401(K) PLAN 2019 631270951 2020-03-12 BAYOUCLINIC, INC. 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-11-01
Business code 621111
Sponsor’s telephone number 2518244985
Plan sponsor’s address 13220 WINTZELL AVE., BAYOU LA BATRE, AL, 36509
BAYOUCLINIC 401(K) PLAN 2018 631270951 2019-06-03 BAYOUCLINIC, INC. 22
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-11-01
Business code 621111
Sponsor’s telephone number 2518244985
Plan sponsor’s address 13833 TAPIA LANE, BAYOU LA BATRE, AL, 36509
BAYOUCLINIC 401(K) PLAN 2017 631270951 2018-06-26 BAYOUCLINIC, INC. 19
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-11-01
Business code 621111
Sponsor’s telephone number 2518244985
Plan sponsor’s address 13833 TAPIA LANE, BAYOU LA BATRE, AL, 36509
BAYOUCLINIC 401(K) PLAN 2016 631270951 2017-05-17 BAYOUCLINIC, INC. 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-11-01
Business code 621111
Sponsor’s telephone number 2518244985
Plan sponsor’s address 13833 TAPIA LANE, BAYOU LA BATRE, AL, 36509
BAYOUCLINIC 401(K) PLAN 2015 631270951 2016-09-19 BAYOUCLINIC, INC. 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-11-01
Business code 621111
Sponsor’s telephone number 2518244985
Plan sponsor’s address 13833 TAPIA LANE, BAYOU LA BATRE, AL, 36509
BAYOUCLINIC 401(K) PLAN 2014 631270951 2015-10-14 BAYOUCLINIC, INC. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-11-01
Business code 621111
Sponsor’s telephone number 2518244985
Plan sponsor’s address 13833 TAPIA LANE, BAYOU LA BATRE, AL, 36509

Signature of
Role Plan administrator
Date 2015-10-14
Name of individual signing JULIE H. TAYLOR

Agent

Name Role
BENJAMIN, REGINA M Agent

Incorporator

Name Role
BENJAMIN, REGINA M Incorporator

Related by officers

BENJAMIN, REGINA M

REMABE, Inc. Bayou La Batre Rural Health Clinic Foundation, Inc.

Related by address

BAYOU LA BATRE, AL

The Bayou Oil Company, Inc. Bayou Trawl Boards & Marine Supply, Inc. Bryant Enterprises, Inc. Bryant Trawlers, Inc. D & H Furniture and Appliance, Inc. Cindy Lynn, Inc. Fishboats, Inc. Forward Pass, Inc. G & S Boats, Inc. Graham Charter Corporation

318 PATRICIAN DRIVESPANISH FORT, AL 36527

REMABE, LLC

Date of last update: 14 Aug 2024

Sources: Alabama Secretary of State

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