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Gulf Coast Dermatology & Skin Care Centre PLLC

Details

Name: Gulf Coast Dermatology & Skin Care Centre PLLC
Jurisdiction: Alabama
Legal type: Foreign Limited Liability Company
Status: Exists
Date of registration: 27 Mar 2009 (16 years ago)
Entity Number: 000-620-055
Register Number: 000620055
County: Mobile
Place of Formation: Florida
Principal Address: 6701 AIRPORT BLVD STE 0232MOBILE, AL 36608
Principal Address ZIP Code: 36608
Registered Office Street Address: 33120 BOARDWALK DRIVESPANISH FORT, AL 36527
Registered Office Street Address ZIP Code: 36527

Activities OFFICE OF MEDICAL DOCTOR-NAICS CODE 621111

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1184078024 2016-04-18 2016-06-29 1620 W. NORTHWEST HWY, SUITE 100, GRAPEVINE, TX, 76051, US 580 PROVIDENCE PARK DR E STE 202, SUITE 202, MOBILE, AL, 366954614, US

Contacts
Phone +1 817-572-0009
Fax 8177201039
Phone +1 251-241-0071
Fax 2512029163

Authorized person
Name TAMMIE MISKIMINS
Role MANAGER, PHARMACY LICENSING/CONTRAC
Phone 8175720009

Taxonomy
Taxonomy Code 333600000X - Pharmacy
License Number 114611
State AL
Is Primary Yes
Taxonomy Code 3336C0003X - Community/Retail Pharmacy
Is Primary No

Other Provider Identifiers
Issuer PK
Number 2159548

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
ADVANCED DERMATOLOGY 401(K) PROFIT SHARING PLAN 2019 264581980 2021-11-02 GULF COAST DERMATOLOGY & SKIN CARE CENTRE, PLLC 42
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621111
Sponsor’s telephone number 2516303570
Plan sponsor’s address 580 PROVIDENCE PARK DRIVE EAST, MOBILE, AL, 36695
ADVANCED DERMATOLOGY 401(K) PROFIT SHARING PLAN 2018 264581980 2019-10-10 GULF COAST DERMATOLOGY & SKIN CARE CENTRE, PLLC 41
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621111
Sponsor’s telephone number 2516303570
Plan sponsor’s address 580 PROVIDENCE PARK DRIVE EAST, MOBILE, AL, 36695

Signature of
Role Plan administrator
Date 2019-10-10
Name of individual signing THOMAS W. BENDER
ADVANCED DERMATOLOGY 401(K) PROFIT SHARING PLAN 2017 264581980 2018-07-05 GULF COAST DERMATOLOGY & SKIN CARE CENTRE, PLLC 26
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621111
Sponsor’s telephone number 2516303570
Plan sponsor’s address 580 PROVIDENCE PARK DRIVE EAST, MOBILE, AL, 36695

Signature of
Role Plan administrator
Date 2018-07-05
Name of individual signing THOMAS W. BENDER
ADVANCED DERMATOLOGY 401(K) PROFIT SHARING PLAN 2016 264581980 2017-10-08 GULF COAST DERMATOLOGY & SKIN CARE CENTRE, PLLC 20
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621111
Sponsor’s telephone number 2516303570
Plan sponsor’s address 580 PROVIDENCE PARK DRIVE EAST, MOBILE, AL, 36695

Signature of
Role Plan administrator
Date 2017-10-08
Name of individual signing THOMAS W. BENDER
GULF COAST DERMATOLOGY & SKIN CARE CENTRE, PLLC 401(K) PROFIT SHARING PLAN 2015 264581980 2016-10-13 GULF COAST DERMATOLOGY & SKIN CARE CENTRE, PLLC 18
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621111
Sponsor’s telephone number 2516313570
Plan sponsor’s address PROVIDENCE PARK, 6701 AIRPORT BLVD., SUITE D-232, MOBILE, AL, 36608

Signature of
Role Plan administrator
Date 2016-10-13
Name of individual signing THOMAS W. BENDER, III
GULF COAST DERMATOLOGY & SKIN CARE CENTRE, PLLC 401(K) PROFIT SHARING PLAN 2014 264581980 2015-10-06 GULF COAST DERMATOLOGY & SKIN CARE CENTRE, PLLC 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621111
Sponsor’s telephone number 2516313570
Plan sponsor’s address PROVIDENCE PARK, 6701 AIRPORT BLVD., SUITE D-232, MOBILE, AL, 36608

Signature of
Role Plan administrator
Date 2015-10-06
Name of individual signing THOMAS W. BENDER, III
GULF COAST DERMATOLOGY & SKIN CARE CENTRE, PLLC 401(K) PROFIT SHARING PLAN 2013 264581980 2014-10-13 GULF COAST DERMATOLOGY & SKIN CARE CENTRE, PLLC 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621111
Sponsor’s telephone number 2516313570
Plan sponsor’s address PROVIDENCE PARK, 6701 AIRPORT BLVD., SUITE D-232, MOBILE, AL, 36608

Signature of
Role Plan administrator
Date 2014-10-13
Name of individual signing THOMAS W. BENDER, III
Role Employer/plan sponsor
Date 2014-10-13
Name of individual signing THOMAS W. BENDER, III
GULF COAST DERMATOLOGY & SKIN CARE CENTRE, PLLC 401(K) PROFIT SHARING PLAN 2012 264581980 2013-09-27 GULF COAST DERMATOLOGY & SKIN CARE CENTRE, PLLC 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621111
Sponsor’s telephone number 2516313570
Plan sponsor’s address PROVIDENCE PARK, 6701 AIRPORT BLVD., SUITE D-232, MOBILE, AL, 36608

Signature of
Role Plan administrator
Date 2013-09-27
Name of individual signing THOMAS W. BENDER, III
Role Employer/plan sponsor
Date 2013-09-27
Name of individual signing THOMAS W. BENDER, III

Agent

Name Role Address
BENDER, THOMAS W III Agent 6701 AIRPORT BLVD SUITE D232MOBILE, AL 36608

Related by officers

BENDER, THOMAS W III

The Wellness and Weight Management Company LLC TWB INVESTMENTS, LLC Gulf Coast Laser, LLC Southern Sports Network LLC FALCON Ghost Fleet Group, LLC Inside the Crimson Tide, LLC

Related by address

33120 BOARDWALK DRIVESPANISH FORT, AL 36527

Bender Clinics LLC Falcon Equipment, LP Cobra High Risk, LLC Bama Safe Assets, LP Bender Clinics Daphne, LLC FALCON Ghost Fleet Group, LLC Inside the Crimson Tide, LLC

Date of last update: 15 Aug 2024

Sources: Alabama Secretary of State

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