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Montevallo Family Medicine, LLC

Details

Name: Montevallo Family Medicine, LLC
Jurisdiction: Alabama
Legal type: Domestic Limited Liability Company
Status: Exists
Date of registration: 01 Apr 2002 (23 years ago)
Entity Number: 000-681-546
Register Number: 000681546
County: Shelby
Place of Formation: Shelby County
Principal Address: MONTEVALLO, AL
Registered Office Street Address: 33 SALEM RD STE 1MONTEVALLO, AL 35115
Registered Office Street Address ZIP Code: 35115

Activities PRACTICE MEDICINE

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1720009962 2006-07-22 2011-11-07 33 SALEM RD, SUITE 1, MONTEVALLO, AL, 351153586, US 33 SALEM RD, SUITE 1, MONTEVALLO, AL, 351153586, US

Contacts
Phone +1 205-665-7991
Fax 2056652913

Authorized person
Name MR. JONATHAN C. MERKLE
Role PHYSICIAN
Phone 2056657991

Taxonomy
Taxonomy Code 207Q00000X - Family Medicine Physician
License Number 21192
State AL
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 529911870
State AL
Issuer MEDICAID
Number 51517997
State AL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
MONTEVALLO FAMILY MEDICINE, LLC 401(K) PLAN 2023 030416268 2024-07-24 MONTEVALLO FAMILY MEDICINE,LLC 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Business code 621111
Sponsor’s telephone number 2056657991
Plan sponsor’s address 33 SALEM ROAD, SUITE 1, MONTEVALLO, AL, 35115
MONTEVALLO FAMILY MEDICINE, LLC 401(K) PLAN 2022 030416268 2023-07-19 MONTEVALLO FAMILY MEDICINE,LLC 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Business code 621111
Sponsor’s telephone number 2056657991
Plan sponsor’s address 33 SALEM ROAD, SUITE 1, MONTEVALLO, AL, 35115
MONTEVALLO FAMILY MEDICINE, LLC 401(K) PLAN 2021 030416268 2022-07-06 MONTEVALLO FAMILY MEDICINE,LLC 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Business code 621111
Sponsor’s telephone number 2056657991
Plan sponsor’s address 33 SALEM ROAD, SUITE 1, MONTEVALLO, AL, 35115
MONTEVALLO FAMILY MEDICINE, LLC 401(K) PLAN 2020 030416268 2021-06-15 MONTEVALLO FAMILY MEDICINE,LLC 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Business code 621111
Sponsor’s telephone number 2056657991
Plan sponsor’s address 33 SALEM ROAD, SUITE 1, MONTEVALLO, AL, 35115
MONTEVALLO FAMILY MEDICINE, LLC 401(K) PLAN 2019 030416268 2020-07-20 MONTEVALLO FAMILY MEDICINE,LLC 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Business code 621111
Sponsor’s telephone number 2056657991
Plan sponsor’s address 33 SALEM ROAD, SUITE 1, MONTEVALLO, AL, 35115
MONTEVALLO FAMILY MEDICINE, LLC 401(K) PLAN 2018 030416268 2019-07-19 MONTEVALLO FAMILY MEDICINE,LLC 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Business code 621111
Sponsor’s telephone number 2056657991
Plan sponsor’s address 33 SALEM ROAD, SUITE 1, MONTEVALLO, AL, 35115
MONTEVALLO FAMILY MEDICINE, LLC 401(K) PLAN 2017 030416268 2018-07-30 MONTEVALLO FAMILY MEDICINE,LLC 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Business code 621111
Sponsor’s telephone number 2056657991
Plan sponsor’s address 33 SALEM ROAD, SUITE 1, MONTEVALLO, AL, 35115

Signature of
Role Plan administrator
Date 2018-07-30
Name of individual signing JONATHAN C. MERKLE, M.D.
MONTEVALLO FAMILY MEDICINE, LLC 401(K) PLAN 2016 030416268 2017-07-27 MONTEVALLO FAMILY MEDICINE,LLC 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Business code 621111
Sponsor’s telephone number 2056657991
Plan sponsor’s address 33 SALEM ROAD, SUITE 1, MONTEVALLO, AL, 35115

Signature of
Role Plan administrator
Date 2017-07-27
Name of individual signing JONATHAN C. MERKLE, M.D.

Agent

Name Role
MERKLE, JONATHAN C Agent

Member

Name Role
MERKLE, JONATHAN C Member

Related by officers

MERKLE, JONATHAN C

Merkle Properties, LLC

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Date of last update: 15 Aug 2024

Sources: Alabama Secretary of State

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