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Pediatric Specialists of Montgomery, LLC

Details

Name: Pediatric Specialists of Montgomery, LLC
Jurisdiction: Alabama
Legal type: Domestic Limited Liability Company
Status: Exists
Date of registration: 18 Jan 2000 (25 years ago) (Companies founded in January 2000)
Entity Number: 000-668-146
Register Number: 000668146
Historical Names: Pediatric Cardiology of Montgomery, LLC
ZIP code: 36116 (Companies in Montgomery, 36116)
County: Montgomery
Place of Formation: Montgomery County
Registered Office Street Address: 2055 EAST SOUTH BLVD STE 509MONTGOMERY, AL 36116

Activities PRACTICE OF MEDICINE

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1891766762 2006-01-30 2020-08-22 239 MITYLENE PARK DR, MONTGOMERY, AL, 361173547, US 239 MITYLENE PARK DR, MONTGOMERY, AL, 361173547, US

Contacts
Phone +1 334-612-2111
Fax 3346122166

Authorized person
Name MEREDITH DAFFIN
Role ADMINISTRATOR
Phone 3346122111

Taxonomy
Taxonomy Code 2080P0202X - Pediatric Cardiology Physician
License Number 16678
State AL
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
PEDIATRIC SPECIALISTS 401K PLAN 2023 631241200 2024-09-04 PEDIATRIC SPECIALISTS OF MONTGOMERY LLC 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621112
Sponsor’s telephone number 3346122111
Plan sponsor’s address 239 MITYLENE PARK DR, MONTGOMERY, AL, 36117

Signature of
Role Plan administrator
Date 2024-09-04
Name of individual signing LYNN TODD
Valid signature Filed with authorized/valid electronic signature
PEDIATRIC SPECIALISTS 401K PLAN 2022 631241200 2023-09-28 PEDIATRIC SPECIALISTS OF MONTGOMERY LLC 17
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621112
Sponsor’s telephone number 3346122111
Plan sponsor’s address 239 MITYLENE PARK DR, MONTGOMERY, AL, 36117

Signature of
Role Plan administrator
Date 2023-09-28
Name of individual signing BARTON COOK MD
PEDIATRIC SPECIALISTS 401K PLAN 2021 631241200 2022-09-28 PEDIATRIC SPECIALISTS OF MONTGOMERY, LLC 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621112
Sponsor’s telephone number 3346122111
Plan sponsor’s address 239 MITYLENE PARK DR, MONTGOMERY, AL, 36117

Signature of
Role Plan administrator
Date 2022-09-28
Name of individual signing BARTON COOK MD
PEDIATRIC SPECIALISTS 401K PLAN 2020 631241200 2021-09-29 PEDIATRIC SPECIALISTS OF MONTGOMERY LLC 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621112
Sponsor’s telephone number 3346122111
Plan sponsor’s address 239 MITYLENE PARK DR, MONTGOMERY, AL, 36117

Signature of
Role Plan administrator
Date 2021-09-29
Name of individual signing BARTON COOK MD
PEDIATRIC SPECIALISTS 401K PLAN 2020 631241200 2021-09-29 PEDIATRIC SPECIALISTS OF MONTGOMERY LLC 15
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621112
Sponsor’s telephone number 3346122111
Plan sponsor’s address 239 MITYLENE PARK DR, MONTGOMERY, AL, 36117

Signature of
Role Plan administrator
Date 2021-09-29
Name of individual signing BARTON COOK MD
PEDIATRIC SPECIALISTS 401K PLAN 2019 631241200 2020-06-11 PEDIATRIC SPECIALISTS OF MONTGOMERY LLC 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621112
Sponsor’s telephone number 3346122111
Plan sponsor’s address 239 MITYLENE PARK DR, MONTGOMERY, AL, 36117

Signature of
Role Plan administrator
Date 2020-06-11
Name of individual signing BARTON COOK MD
PEDIATRIC SPECIALISTS 401K PLAN 2018 631241200 2019-06-25 PEDIATRIC SPECIALISTS OF MONTGOMERY LLC 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621112
Sponsor’s telephone number 3346122111
Plan sponsor’s address 239 MITYLENE PARK DR, MONTGOMERY, AL, 36117

Signature of
Role Plan administrator
Date 2019-06-25
Name of individual signing BARTON COOK MD
PEDIATRIC SPECIALISTS 401K PLAN 2017 631241200 2018-08-20 PEDIATRIC SPECIALISTS OF MONTGOMERY LLC 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621112
Sponsor’s telephone number 3346122111
Plan sponsor’s address 239 MITYLENE PARK DR, MONTGOMERY, AL, 36117

Signature of
Role Plan administrator
Date 2018-08-20
Name of individual signing BARTON COOK MD
PEDIATRIC SPECIALISTS 401(K) PLAN 2016 631241200 2017-05-12 PEDIATRIC SPECIALISTS OF MONTGOMERY, LLC 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621112
Sponsor’s telephone number 3346122111
Plan sponsor’s address 239 MITYLENE PARK DRIVE, MONTGOMERY, AL, 36117

Signature of
Role Plan administrator
Date 2017-05-12
Name of individual signing BARTON B COOK
Role Employer/plan sponsor
Date 2017-05-12
Name of individual signing BARTON B COOK
PEDIATRIC SPECIALISTS 401(K) PLAN 2015 631241200 2016-05-25 PEDIATRIC SPECIALISTS OF MONTGOMERY LLC 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 3346122111
Plan sponsor’s address 239 MITYLENE PARK DRIVE, MONTGOMERY, AL, 36117

Signature of
Role Plan administrator
Date 2016-05-25
Name of individual signing BARTON COOK, MD
Role Employer/plan sponsor
Date 2016-05-25
Name of individual signing BARTON COOK, MD

Member

Name Role Address
COOK, BARTON B Member 239 MITYLENE PARK DRIVEMONTGOMERY, AL 36117

Organizer

Name Role Address
COOK, BARTON B Organizer 239 MITYLENE PARK DRIVEMONTGOMERY, AL 36117
GONZALEZ, GERARDO Organizer 239 MITYLENE PARK DRIVEMONTGOMERY, AL 36117

Agent

Name Role Address
COOK, BARTON B Agent 239 MITYLENE PARK DRIVEMONTGOMERY, AL 36117

Events

Event Date Event Type Old Value New Value
2002-07-18 Name Change Pediatric Cardiology of Montgomery, LLC Pediatric Specialists of Montgomery, LLC

Related by officers

COOK, BARTON B

Barton B. Cook, M.D., P.C. CHK Homes, LLC Medical Properties East, LLC

GONZALEZ, GERARDO

Gerardo Gonzalez, M.D., P.C. Medical Properties East, LLC

Related by address

No related companies by address

Date of last update: 15 Aug 2024

Sources: Alabama Secretary of State

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