| Name: | Thomas M. Davis, Jr. MD, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 20 Mar 2003 (22 years ago) (Companies founded in March 2003) |
| Entity Number: | 000-689-055 |
| Register Number: | 000689055 |
| ZIP code: | 35406 (Companies in Tuscaloosa, 35406) |
| County: | Tuscaloosa |
| Place of Formation: | Tuscaloosa County |
| Principal Address: | TUSCALOOSA, AL |
| Registered Office Street Address: | 2320 WESTMINSTER LNTUSCALOOSA, AL 35406 |
Activities
OWN/OPERATE A MEDICAL PRACTICE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1588755995 | 2006-09-28 | 2020-08-22 | 700 HELEN KELLER BLVD, TUSCALOOSA, AL, 354042960, US | 700 HELEN KELLER BLVD, TUSCALOOSA, AL, 354042960, US | |||||||||||||||||||||||||||||||||||||||
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| Phone | +1 205-556-9400 |
| Fax | 2055564655 |
Authorized person
| Name | MS. PAMELA A BOJO |
| Role | OFFICE MANAGER |
| Phone | 2055569400 |
Taxonomy
| Taxonomy Code | 152W00000X - Optometrist |
| License Number | SA36TA590 |
| State | AL |
| Is Primary | No |
| Taxonomy Code | 207W00000X - Ophthalmology Physician |
| License Number | 14788 |
| State | AL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | BCBS |
| Number | 51522034 |
| State | AL |
| Issuer | BCBS |
| Number | 83834 |
| State | AL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| THOMAS M. DAVIS JR. , MD 401(K) PROFIT SHARING PLAN | 2023 | 631049064 | 2024-07-05 | THOMAS M. DAVIS JR., MD LLC | 12 | |||||||||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2024-07-05 |
| Name of individual signing | THOMAS DAVIS |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2022-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 2055569400 |
| Plan sponsor’s address | 700 HELEN KELLER BOULEVARD, TUSCALOUSA, AL, 35404 |
Signature of
| Role | Plan administrator |
| Date | 2023-10-15 |
| Name of individual signing | THOMAS DAVIS |
| Role | Employer/plan sponsor |
| Date | 2023-10-15 |
| Name of individual signing | THOMAS DAVIS |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 1992-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 2055569400 |
| Plan sponsor’s address | 700 HELEN KELLER BOULEVARD, TUSCALOOSA, AL, 35404 |
Signature of
| Role | Plan administrator |
| Date | 2022-06-27 |
| Name of individual signing | THOMAS DAVIS |
| Name | Role |
|---|---|
| DAVIS, THOMAS M JR | Agent |
| Name | Role |
|---|---|
| DAVIS, THOMAS M JR | Member |
Date of last update: 15 Aug 2024
Sources: Alabama Secretary of State
