| Name: | The Surgery Clinic, L.L.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 02 Jan 2003 (22 years ago) |
| Entity Number: | 000-686-895 |
| Register Number: | 000686895 |
| County: | Etowah |
| Place of Formation: | Etowah County |
| Registered Office Street Address: | 419 S 5TH STGADSDEN, AL 35901 |
| Registered Office Street Address ZIP Code: | 35901 |
| Principal Address: | GADSDEN, AL |
Activities
MEDICINE PRACTICE
| Unique Entity ID | Expiration Date | Physical Address | Mailing Address | |||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JAQ9DKRSMGB7 | 2024-02-08 | 419 S 5TH ST, GADSDEN, AL, 35901, 5101, USA | 419 S 5TH ST, GADSDEN, AL, 35901, 5101, USA | |||||||||||||||||||||||||||||||||||||||||||||||||
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| Congressional District | 04 |
| State/Country of Incorporation | AL, USA |
| Activation Date | 2023-02-10 |
| Initial Registration Date | 2021-03-08 |
| Entity Start Date | 2003-09-30 |
| Fiscal Year End Close Date | Dec 31 |
Points of Contacts
| Electronic Business | |
|---|---|
| Title | PRIMARY POC |
| Name | ANDREA LEDFORD |
| Role | BILLING MANAGER |
| Address | 419 SOUTH 5TH STREET, GADSDEN, AL, 35901, 5101, USA |
| Government Business | |
|---|---|
| Title | PRIMARY POC |
| Name | GAIL HARE |
| Role | OFFICE MANAGER |
| Address | 419 S 5TH ST, GADSDEN, AL, 35901, 5101, USA |
| Past Performance | |
|---|---|
| Title | ALTERNATE POC |
| Name | ANDREA LEDFORD |
| Role | BILLING MANAGER |
| Address | 419 SOUTH 5TH STREET, GADSDEN, AL, 35901, USA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1780068460 | 2015-07-13 | 2021-02-10 | 419 S 5TH ST, GADSDEN, AL, 359015101, US | 1622 CHURCH AVE SE, JACKSONVILLE, AL, 362653200, US | |||||||||||||||||||||||
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| Phone | +1 256-547-6331 |
| Fax | 2565471711 |
Authorized person
| Name | MRS. DIANETTE KEENER |
| Role | BILLING MANAGER |
| Phone | 2565476331 |
Taxonomy
| Taxonomy Code | 208600000X - Surgery Physician |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 528202650 |
| State | AL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| THE SURGERY CLINIC, L.L.C. PROFIT SHARING PLAN | 2023 | 630952320 | 2024-06-26 | THE SURGERY CLINIC, L.L.C. | 13 | |||||||||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2024-06-26 |
| Name of individual signing | GAIL HARE |
| Role | Employer/plan sponsor |
| Date | 2024-06-26 |
| Name of individual signing | GAIL HARE |
| File | View Page |
| Three-digit plan number (PN) | 002 |
| Effective date of plan | 1975-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 2565438902 |
| Plan sponsor’s address | 419 SOUTH 5TH STREET, GADSDEN, AL, 35901 |
Signature of
| Role | Plan administrator |
| Date | 2024-08-19 |
| Name of individual signing | GAIL HARE |
| Role | Employer/plan sponsor |
| Date | 2024-08-19 |
| Name of individual signing | GAIL HARE |
| Name | Role |
|---|---|
| SLIGH, JANE E | Agent |
| Name | Role | Address |
|---|---|---|
| CAMPBELL, JOHN H | Member | No data |
| BRIDGES, W MCFARLAND II | Member | No data |
| NEWMAN, LUCIAN III | Member | 207 DOGWOOD CIRCLEGADSDEN, AL 35901 |
| NEWMAN, CHARLES LEATHERBURY | Member | No data |
| NEWMAN, LUCIAN JR | Member | No data |
Date of last update: 15 Aug 2024
Sources: Alabama Secretary of State
