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ENT Bessemer, LLC

Details

Name: ENT Bessemer, LLC
Jurisdiction: Alabama
Legal type: Domestic Limited Liability Company
Status: Exists
Date of registration: 20 Oct 1998 (26 years ago) (Companies founded in October 1998)
Entity Number: 000-661-625
Register Number: 000661625
ZIP code: 35023 (Companies in Jefferson, 35023)
County: Jefferson
Place of Formation: Jefferson County
Principal Address: BESSEMER, AL
Registered Office Street Address: 985 9TH AVE SW STE 308BESSEMER, AL 35023

Activities MANAGE A MEDICAL PRACTICE

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1639337934 2008-05-23 2011-08-15 985 9TH AVE SW, SUITE 308, BESSEMER, AL, 350224500, US 985 9TH AVE SW, SUITE 308, BESSEMER, AL, 350224500, US

Contacts
Phone +1 205-481-7780
Fax 2054817740

Authorized person
Name GRETCHEN K GILLILAND
Role BILLING
Phone 2054817780

Taxonomy
Taxonomy Code 207Y00000X - Otolaryngology Physician
License Number 12109
State AL
Is Primary Yes

Other Provider Identifiers
Issuer UNITED HEALTHCARE
Number 1010135
State TX
Issuer BLUE CROSS OF ALABAMA
Number 51045124
State AL
Issuer TRICARE
Number 420842449
State SC
Issuer MEDICAID
Number 529900180
State AL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
ENT BESSEMER LLC RETIREMENT PLAN 2022 631209111 2023-10-15 ENT BESSEMER LLC 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621111
Sponsor’s telephone number 2058238928
Plan sponsor’s address 985 9TH AVE SW #308, BESSEMER, AL, 35022

Signature of
Role Plan administrator
Date 2023-10-16
Name of individual signing GRETCHEN GILLILAND
ENT BESSEMER LLC RETIREMENT PLAN 2021 631209111 2022-10-15 ENT BESSEMER LLC 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621111
Sponsor’s telephone number 2058238928
Plan sponsor’s address 985 9TH AVE SW #308, BESSEMER, AL, 35022

Signature of
Role Plan administrator
Date 2022-10-15
Name of individual signing GRETCHEN GILLILAND
ENT BESSEMER LLC RETIREMENT PLAN 2020 631209111 2021-10-14 ENT BESSEMER LLC 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621111
Sponsor’s telephone number 2058238928
Plan sponsor’s address 985 9TH AVE SW #308, BESSEMER, AL, 35022

Signature of
Role Plan administrator
Date 2021-10-14
Name of individual signing GRETCHEN GILLILAND
ENT BESSEMER LLC RETIREMENT PLAN 2019 631209111 2020-10-14 ENT BESSEMER LLC 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621111
Sponsor’s telephone number 2058238928
Plan sponsor’s address 985 9TH AVENUE SW SUITE 308, BIRMINGHAM, AL, 35023

Signature of
Role Plan administrator
Date 2020-10-14
Name of individual signing GRETCHEN GILLILAND
ENT BESSEMER LLC RETIREMENT PLAN 2018 631209111 2019-10-15 ENT BESSEMER LLC 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621111
Sponsor’s telephone number 2058238928
Plan sponsor’s address 985 9TH AVENUE SW SUITE 308, BIRMINGHAM, AL, 35023

Signature of
Role Plan administrator
Date 2019-10-15
Name of individual signing GRETCHEN GILLILAND
ENT BESSEMER LLC RETIREMENT PLAN 2017 631209111 2018-10-15 ENT BESSEMER LLC 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621111
Sponsor’s telephone number 2058238928
Plan sponsor’s address 985 9TH AVENUE SW SUITE 308, BIRMINGHAM, AL, 35023

Signature of
Role Plan administrator
Date 2018-10-15
Name of individual signing GRETCHEN GILLILAND
ENT BESSEMER LLC RETIREMENT PLAN 2016 631209111 2017-10-13 ENT BESSEMER LLC 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621111
Sponsor’s telephone number 2058238928
Plan sponsor’s address 985 9TH AVENUE SW SUITE 308, BIRMINGHAM, AL, 35023

Signature of
Role Plan administrator
Date 2017-10-13
Name of individual signing GRETCHEN GILLILAND
ENT BESSEMER LLC RETIREMENT PLAN 2015 631209111 2016-10-13 ENT BESSEMER LLC 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621111
Sponsor’s telephone number 2058238928
Plan sponsor’s address 985 9TH AVENUE SW SUITE 308, BIRMINGHAM, AL, 35023

Signature of
Role Plan administrator
Date 2016-10-13
Name of individual signing GRETCHEN GILLILAND
ENT BESSEMER LLC RETIREMENT PLAN 2014 631209111 2015-10-13 ENT BESSEMER LLC 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621111
Sponsor’s telephone number 2058238928
Plan sponsor’s address 985 9TH AVENUE SW SUITE 308, BIRMINGHAM, AL, 35023

Signature of
Role Plan administrator
Date 2015-10-13
Name of individual signing GRETCHEN GILLILAND
ENT BESSEMER LLC RETIREMENT PLAN 2013 631209111 2014-10-14 ENT BESSEMER LLC 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621111
Sponsor’s telephone number 2058238928
Plan sponsor’s address 985 9TH AVENUE SW SUITE 308, BIRMINGHAM, AL, 35023

Signature of
Role Plan administrator
Date 2014-10-14
Name of individual signing GRETCHEN GILLILAND

Agent

Name Role
GILLILAND, RICHARD E Agent

Member

Name Role
GILLILAND, RICHARD E Member

Related by officers

No related officers

Related by address

BESSEMER, AL

Alabama Exterminators, Inc. Alliance Community Center Auto Armature Service Company, Inc. Bessemer Glass Industries, Inc. B & R Backhoe Service, Inc. B-S Developers, Incorporated Bessemer Apothecary Company Bessemer Automotive and Industrial Supply Company, Inc. Bessemer Dental Clinic, Inc. Bessemer Electric Motor Co., Inc.

Date of last update: 15 Aug 2024

Sources: Alabama Secretary of State

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