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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)
Entity Number: 000-668-146
Register Number: 000668146
Historical Names: Pediatric Cardiology of Montgomery, LLC
County: Montgomery
Place of Formation: Montgomery County
Registered Office Street Address: 2055 EAST SOUTH BLVD STE 509MONTGOMERY, AL 36116
Registered Office Street Address ZIP Code: 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

Date of last update: 15 Aug 2024

Sources: Alabama Secretary of State