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Tuskaloosa Internal Medicine, LLC

Details

Name: Tuskaloosa Internal Medicine, LLC
Jurisdiction: Alabama
Legal type: Domestic Limited Liability Company
Status: Exists
Date of registration: 29 Jun 1994 (30 years ago)
Entity Number: 000-650-708
Register Number: 000650708
Historical Names: Baker, Burnum, Miller & Summerford, L.L.C.
Baker, Burnum, Miller, Summerford & Vaughn, L.L.C.
County: Tuscaloosa
Place of Formation: Tuscaloosa County
Principal Address: 1100 RUBY TYLER PARKWAYTUSCALOOSA, AL 35404
Principal Address ZIP Code: 35404
Registered Office Street Address: 1100 RUBY TYLER PKWYTUSCALOOSA, AL 35404
Registered Office Street Address ZIP Code: 35404

Activities PRACTICE OF MEDICINE/RENDERING ANCILLARY SERVICES THERETO

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1235221847 2006-09-29 2013-03-01 1100 RUBY TYLER PKWY, TUSCALOOSA, AL, 354042959, US 1100 RUBY TYLER PKWY, TUSCALOOSA, AL, 354042959, US

Contacts
Phone +1 205-759-2582
Fax 2057592985

Authorized person
Name ROSS B VAUGHN
Role PARTNER
Phone 2057592582

Taxonomy
Taxonomy Code 207R00000X - Internal Medicine Physician
State AL
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 528601940
State AL
Issuer RAILROAD MEDICARE
Number CC0235
State AL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
TUSKALOOSA INTERNAL MEDICINE, LLC. RETIREMENT PLAN 2023 630479242 2024-09-18 TUSKALOOSA INTERNAL MEDICINE, LLC 61
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1969-01-01
Business code 621111
Sponsor’s telephone number 2057592582
Plan sponsor’s address 1100 RUBY TYLER PKWY., TUSCALOOSA, AL, 354042959

Signature of
Role Plan administrator
Date 2024-09-18
Name of individual signing STACY HOLLIDAY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2024-09-18
Name of individual signing JOHN P SUMMERFORD
Valid signature Filed with authorized/valid electronic signature
TUSKALOOSA INTERNAL MEDICINE LLC, RETIREMENT PLAN 2022 630479242 2023-10-10 TUSKALOOSA INTERNAL MEDICINE, LLC 63
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1969-01-01
Business code 621111
Sponsor’s telephone number 2057592582
Plan sponsor’s address 1100 RUBY TYLER PKWY., TUSCALOOSA, AL, 354042959

Signature of
Role Plan administrator
Date 2023-10-10
Name of individual signing STACY HOLLIDAY
Role Employer/plan sponsor
Date 2023-10-10
Name of individual signing JOHN P SUMMERFORD
TUSKALOOSA INTERNAL MEDICINE LLC, RETIREMENT PLAN 2021 630479242 2022-10-11 TUSKALOOSA INTERNAL MEDICINE, LLC 76
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1969-01-01
Business code 621111
Sponsor’s telephone number 2057592582
Plan sponsor’s address 1100 RUBY TYLER PKWY., TUSCALOOSA, AL, 354042959

Signature of
Role Plan administrator
Date 2022-10-11
Name of individual signing STACY HOLLIDAY
Role Employer/plan sponsor
Date 2022-10-11
Name of individual signing JOHN SUMMERFORD
TUSKALOOSA INTERNAL MEDICINE LLC, RETIREMENT PLAN 2020 630479242 2021-10-06 TUSKALOOSA INTERNAL MEDICINE, LLC 76
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1969-01-01
Business code 621111
Sponsor’s telephone number 2057592582
Plan sponsor’s address 1100 RUBY TYLER PKWY., TUSCALOOSA, AL, 354042959

Signature of
Role Plan administrator
Date 2021-10-06
Name of individual signing STACY HOLLIDAY
Role Employer/plan sponsor
Date 2021-10-06
Name of individual signing JOHN SUMMERFORD
TUSKALOOSA INTERNAL MEDICINE LLC, RETIREMENT PLAN 2019 630479242 2020-07-30 TUSKALOOSA INTERNAL MEDICINE, LLC 75
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1969-01-01
Business code 621111
Sponsor’s telephone number 2057592582
Plan sponsor’s address 1100 RUBY TYLER PKWY., TUSCALOOSA, AL, 354042959

Signature of
Role Plan administrator
Date 2020-07-30
Name of individual signing STACY HOLLIDAY
Role Employer/plan sponsor
Date 2020-07-30
Name of individual signing JOHN SUMMERFORD
TUSKALOOSA INTERNAL MEDICINE LLC, RETIREMENT PLAN 2018 630479242 2019-08-21 TUSKALOOSA INTERNAL MEDICINE, LLC 68
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1969-01-01
Business code 621111
Sponsor’s telephone number 2057592582
Plan sponsor’s address 1100 RUBY TYLER PKWY., TUSCALOOSA, AL, 354042959

Signature of
Role Plan administrator
Date 2019-08-21
Name of individual signing STACY HOLLIDAY
Role Employer/plan sponsor
Date 2019-08-21
Name of individual signing JOHN SUMMERFORD
TUSKALOOSA INTERNAL MEDICINE LLC, RETIREMENT PLAN 2017 630479242 2018-06-27 TUSKALOOSA INTERNAL MEDICINE, LLC 67
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1969-01-01
Business code 621111
Sponsor’s telephone number 2057592582
Plan sponsor’s address 1100 RUBY TYLER PKWY., TUSCALOOSA, AL, 354042959

Signature of
Role Plan administrator
Date 2018-06-27
Name of individual signing STACY HOLLIDAY
TUSKALOOSA INTERNAL MEDICINE LLC, RETIREMENT PLAN 2016 630479242 2017-06-23 TUSKALOOSA INTERNAL MEDICINE, LLC 62
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1969-01-01
Business code 621111
Sponsor’s telephone number 2057592582
Plan sponsor’s address 1100 RUBY TYLER PKWY., TUSCALOOSA, AL, 354042959

Signature of
Role Plan administrator
Date 2017-06-23
Name of individual signing STACY HOLLIDAY
Role Employer/plan sponsor
Date 2017-06-23
Name of individual signing STACY HOLLIDAY
TUSKALOOSA INTERNAL MEDICINE LLC, RETIREMENT PLAN 2015 630479242 2016-05-10 TUSKALOOSA INTERNAL MEDICINE, LLC 61
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1969-01-01
Business code 621111
Sponsor’s telephone number 2057592582
Plan sponsor’s address 1100 RUBY TYLER PKWY., TUSCALOOSA, AL, 354042959

Signature of
Role Plan administrator
Date 2016-05-10
Name of individual signing STACY HOLLIDAY
Role Employer/plan sponsor
Date 2016-05-10
Name of individual signing STACY HOLLIDAY
TUSKALOOSA INTERNAL MEDICINE LLC, RETIREMENT PLAN 2014 630479242 2015-06-30 TUSKALOOSA INTERNAL MEDICINE LLC 53
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1969-01-01
Business code 621111
Sponsor’s telephone number 2057592582
Plan sponsor’s address 1100 RUBY TYLER PKWY., TUSCALOOSA, AL, 354042959

Signature of
Role Plan administrator
Date 2015-06-30
Name of individual signing STACY HOLLIDAY

Organizer

Name Role Address
VAUGHN, ROSS B Organizer 1100 RUBY TYLER PARKWAYTUSCALOOSA, AL 35401
JONES, LEONARD W III Organizer 1100 RUBY TYLER PARKWAYTUSCALOOSA, AL 35401
FULGHAM, SCOTT R Organizer 1100 RUBY TYLER PARKWAYTUSCALOOSA, AL 35401
MILLER, JOHN P Organizer 1100 RUBY TYLER PARKWAYTUSCALOOSA, AL 35401
WARREN, JOHN S Organizer 1100 RUBY TYLER PARKWAYTUSCALOOSA, AL 35401
ARNOLD, SCOTT L Organizer 1100 RUBY TYLER PARKWAYTUSCALOOSA, AL 35401
MILLER, GEORGE P Organizer 1100 RUBY TYLER PARKWAYTUSCALOOSA, AL 35401
SUMMERFORD, JOHN P Organizer 1100 RUBY TYLER PARKWAYTUSCALOOSA, AL 35401

Agent

Name Role Address
MILLER, GEORGE P Agent 1100 RUBY TYLER PARKWAYTUSCALOOSA, AL 35401

Member

Name Role Address
MILLER, GEORGE P Member 1100 RUBY TYLER PARKWAYTUSCALOOSA, AL 35401
SUMMERFORD, JOHN P Member 1100 RUBY TYLER PARKWAYTUSCALOOSA, AL 35401
VAUGHN, ROSS B Member 1100 RUBY TYLER PARKWAYTUSCALOOSA, AL 35401
JONES, LEONARD W III Member 1100 RUBY TYLER PARKWAYTUSCALOOSA, AL 35401
FULGHAM, SCOTT R Member 1100 RUBY TYLER PARKWAYTUSCALOOSA, AL 35401
MILLER, JOHN P Member 1100 RUBY TYLER PARKWAYTUSCALOOSA, AL 35401
WARREN, JOHN S Member 1100 RUBY TYLER PARKWAYTUSCALOOSA, AL 35401
ARNOLD, SCOTT L Member 1100 RUBY TYLER PARKWAYTUSCALOOSA, AL 35401

Events

Event Date Event Type Old Value New Value
2000-02-18 Name Change Baker, Burnum, Miller, Summerford & Vaughn, L.L.C. Tuskaloosa Internal Medicine, LLC
1997-09-17 Name Change Baker, Burnum, Miller & Summerford, L.L.C. Baker, Burnum, Miller, Summerford & Vaughn, L.L.C.
1994-07-12 Name Merged No data BAKER, BURNUM, MILLER & SUMMERFORD (AL-GP) Non-Qualified Foreign Into Domestic

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FULGHAM, SCOTT R

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WARREN, JOHN S

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ARNOLD, SCOTT L

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MILLER, GEORGE P

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SUMMERFORD, JOHN P

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Related by address

1100 RUBY TYLER PARKWAYTUSCALOOSA, AL 35404

P&P Investments, LLC

Date of last update: 15 Aug 2024

Sources: Alabama Secretary of State

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