| Name: | Cullman Pain & Wellness, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 26 Aug 2020 (4 years ago) |
| Entity Number: | 000-646-681 |
| Register Number: | 000646681 |
| County: | Jefferson |
| Place of Formation: | Jefferson County |
| Registered Office Street Address: | 2215 DECATUR HWY STE 101GARDENDALE, AL 35071 |
| Registered Office Street Address ZIP Code: | 35071 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1629667837 | 2021-01-12 | 2022-08-01 | 1701 MAIN AVE SW STE E, CULLMAN, AL, 350555385, US | 1701 MAIN AVE SW STE E, CULLMAN, AL, 350555385, US | |||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||
| Phone | +1 256-737-4100 |
Authorized person
| Name | RICKY BRIAN TUBBS |
| Role | OWNER |
| Phone | 2056088199 |
Taxonomy
| Taxonomy Code | 207LP2900X - Pain Medicine (Anesthesiology) Physician |
| Is Primary | Yes |
| Taxonomy Code | 332B00000X - Durable Medical Equipment & Medical Supplies |
| Is Primary | No |
| Taxonomy Code | 332BC3200X - Customized Equipment (DME) |
| Is Primary | No |
Other Provider Identifiers
| Issuer | STATE LICENSE |
| Number | DO1004 |
| State | AL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| CULLMAN PAIN & WELLNESS LLC 401(K) PROFIT SHARING PLAN & TRUST | 2023 | 852936329 | 2024-07-15 | CULLMAN PAIN & WELLNESS LLC | 31 | |||||||||||||||||||||
|
||||||||||||||||||||||||||
| Role | Plan administrator |
| Date | 2024-07-15 |
| Name of individual signing | EDWARD ROJAS |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2020-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 2056088199 |
| Plan sponsor’s address | 2215 DECATUR HWY STE 101, GARDENDALE, AL, 35071 |
Signature of
| Role | Plan administrator |
| Date | 2023-07-31 |
| Name of individual signing | EDWARD ROJAS |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2020-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 2056088199 |
| Plan sponsor’s address | 2215 DECATUR HWY STE 101, GARDENDALE, AL, 35071 |
Signature of
| Role | Plan administrator |
| Date | 2022-04-11 |
| Name of individual signing | EDWARD ROJAS |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2020-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 2056088199 |
| Plan sponsor’s address | 2215 DECATUR HWY STE 101, GARDENDALE, AL, 35071 |
Signature of
| Role | Plan administrator |
| Date | 2021-07-09 |
| Name of individual signing | EDWARD ROJAS |
| Name | Role | Address |
|---|---|---|
| IRBY, RUSSELL L | Organizer | 1819 FIFTH AVENUE N STE 1000BIRMINGHAM, AL 35203 |
| Name | Role | Address |
|---|---|---|
| TUBBS, RICKY | Agent | 1122 SHADY LANE CIRTALLADEGA, AL 35160 |
Date of last update: 15 Aug 2024
Sources: Alabama Secretary of State
