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The Brewton Medical Center, LLC

Details

Name: The Brewton Medical Center, LLC
Jurisdiction: Alabama
Legal type: Domestic Limited Liability Company
Status: Dissolved
Date of registration: 03 Jan 1994 (31 years ago)
Date of dissolution: 15 Jul 2021
Entity Number: 000-650-183
Register Number: 000650183
County: Escambia
Place of Formation: Escambia County
Registered Office Street Address: 1121 BELLEVILLE AVEBREWTON, AL 36426
Registered Office Street Address ZIP Code: 36426
Registered Office Mailing Address: PO BOX 648BREWTON, AL 36427
Registered Office Mailing Address ZIP Code: 36427
Principal Address: 1335 MCMILLAN AVEBREWTON, AL 36426
Principal Address ZIP Code: 36426

Activities PRACTICE OF MEDICINE & ALL ASPECTS OF THE HEALING ARTS

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1336196856 2006-05-29 2011-07-01 PO BOX 648, BREWTON, AL, 364270648, US 1121 BELLEVILLE AVE, BREWTON, AL, 364261505, US

Contacts
Phone +1 251-867-6071
Fax 2518675999

Authorized person
Name VICTOR HUNT JR.
Role ADMINISTRATOR
Phone 2518676071

Taxonomy
Taxonomy Code 207Q00000X - Family Medicine Physician
Is Primary Yes
Taxonomy Code 207RC0000X - Cardiovascular Disease Physician
Is Primary No
Taxonomy Code 207V00000X - Obstetrics & Gynecology Physician
Is Primary No
Taxonomy Code 208000000X - Pediatrics Physician
Is Primary No

Other Provider Identifiers
Issuer MEDICAID
Number 000060008
State AL
Issuer MEDICARE/RAILROAD MEDICAR
Number CB0244
State AL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
BREWTON MEDICAL CENTER, LLC EMPLOYEE SAVINGS & PROFIT SHARING PLAN 2020 630351241 2021-09-20 BREWTON MEDICAL CENTER, LLC 66
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1986-01-01
Business code 621111
Sponsor’s telephone number 2518093103
Plan sponsor’s address 1121 BELLEVILLE AVENUE, BREWTON, AL, 36426

Signature of
Role Plan administrator
Date 2021-09-20
Name of individual signing TOMMY SHEHAN
Role Employer/plan sponsor
Date 2021-09-20
Name of individual signing TOMMY SHEHAN
BREWTON MEDICAL CTR, LLC EE SAVINGS & PS PLAN 2019 630351241 2020-10-05 BREWTON MEDICAL CENTER, LLC 62
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1986-01-01
Business code 621111
Sponsor’s telephone number 2518093103
Plan sponsor’s address 1121 BELLEVILLE AVENUE, BREWTON, AL, 36426

Signature of
Role Plan administrator
Date 2020-10-05
Name of individual signing TOMMY SHEHAN
BREWTON MEDICAL CTR, LLC EE SAVINGS & PS PLAN 2018 630351241 2019-10-07 BREWTON MEDICAL CENTER, LLC 64
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1986-01-01
Business code 621111
Sponsor’s telephone number 2518093103
Plan sponsor’s address 1121 BELLEVILLE AVENUE, BREWTON, AL, 36426

Signature of
Role Plan administrator
Date 2019-10-07
Name of individual signing TOMMY R SHEHAN
Role Employer/plan sponsor
Date 2019-10-07
Name of individual signing TOMMY R SHEHAN
BREWTON MEDICAL CTR, LLC EE SAVINGS & PS PLAN 2017 630351241 2018-06-29 BREWTON MEDICAL CENTER, LLC 77
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1986-01-01
Business code 621111
Sponsor’s telephone number 2518093103
Plan sponsor’s address 1121 BELLEVILLE AVENUE, BREWTON, AL, 36426

Signature of
Role Plan administrator
Date 2018-06-29
Name of individual signing TOMMY SHEHAN
BREWTON MEDICAL CENTER, LLC EMPLOYEE SAVINGS & PROFIT SHARING PLAN 2016 630351241 2017-10-04 BREWTON MEDICAL CENTER, LLC 79
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1986-01-01
Business code 621111
Sponsor’s telephone number 2518093103
Plan sponsor’s address P.O. BOX 648, BREWTON, AL, 364270648
BREWTON MEDICAL CENTER, L.L.C. PROFIT SHARING PLAN 2015 630351241 2016-10-03 BREWTON MEDICAL CENTER, LLC 77
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1986-01-01
Business code 621111
Sponsor’s telephone number 2518676071
Plan sponsor’s address P.O. BOX 648, BREWTON, AL, 364270648

Signature of
Role Plan administrator
Date 2016-10-03
Name of individual signing TOMMY SHEHAN
BREWTON MEDICAL CENTER, L.L.C. PROFIT SHARING PLA 2014 630351241 2015-10-05 BREWTON MEDICAL CENTER, LLC 100
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1986-01-01
Business code 621111
Sponsor’s telephone number 2518676071
Plan sponsor’s address P.O. BOX 648, BREWTON, AL, 364270648

Signature of
Role Plan administrator
Date 2015-10-05
Name of individual signing TOMMY SHEHAN
BREWTON MEDICAL CENTER, L.L.C. PROFIT SHARING PLA 2013 630351241 2014-10-02 BREWTON MEDICAL CENTER, LLC 108
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1986-01-01
Business code 621111
Sponsor’s telephone number 2518676071
Plan sponsor’s address P.O. BOX 648, BREWTON, AL, 364270648

Signature of
Role Plan administrator
Date 2014-10-02
Name of individual signing TOMMY SHEEHAN
BREWTON MEDICAL CENTER, L.L.C. PROFIT SHARING PLAN 2012 630351241 2013-10-14 BREWTON MEDICAL CENTER, LLC 81
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1986-01-01
Business code 621111
Sponsor’s telephone number 2518676071
Plan sponsor’s address P O BOX 648, BREWTON, AL, 364270648

Plan administrator’s name and address
Administrator’s EIN 630351241
Plan administrator’s name BREWTON MEDICAL CENTER, LLC
Plan administrator’s address P O BOX 648, BREWTON, AL, 364270648
Administrator’s telephone number 2518676071

Signature of
Role Plan administrator
Date 2013-10-14
Name of individual signing TOMMY SHEHAN
BREWTON MEDICAL CENTER, L.L.C. PROFIT SHARING PLAN 2011 630351241 2012-10-15 BREWTON MEDICAL CENTER, LLC 80
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1986-01-01
Business code 621111
Sponsor’s telephone number 2518676071
Plan sponsor’s address P O BOX 648, BREWTON, AL, 364270648

Plan administrator’s name and address
Administrator’s EIN 630351241
Plan administrator’s name BREWTON MEDICAL CENTER, LLC
Plan administrator’s address P O BOX 648, BREWTON, AL, 364270648
Administrator’s telephone number 2518676071

Signature of
Role Plan administrator
Date 2012-10-15
Name of individual signing TOMMY SHEHAN

Agent

Name Role
SHEHAN, TOMMY Agent

Member

Name Role
ADKISSON, JIMMY W DO Member
HAYES, ROBERT L MD Member
LOW, ELIZABETH J MD Member
ROBINSON, MARK E MD Member
TERRELL, JOE FRANK MD Member
WALKER, JAMES J MD Member
WHITTLE, WILLIAM H MD Member

Related by officers

No related officers

Related by address

1121 BELLEVILLE AVEBREWTON, AL 36426

R. Scott Nelson, M.D. P.C. LoDuca Pediatrics, LLC

Date of last update: 15 Aug 2024

Sources: Alabama Secretary of State

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