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ABC Pediatric Clinic, LLC

Details

Name: ABC Pediatric Clinic, LLC
Jurisdiction: Alabama
Legal type: Domestic Limited Liability Company
Status: Exists
Date of registration: 22 May 2003 (21 years ago)
Entity Number: 000-690-296
Register Number: 000690296
County: Cullman
Place of Formation: Cullman County
Principal Address: CULLMAN, AL
Registered Office Street Address: 1900 MAIN AVENUE SWCULLMAN, AL 35055
Registered Office Street Address ZIP Code: 35055

Activities PROVIDE PROFESSIONAL MEDICAL SERVICES

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1447439237 2007-10-29 2011-03-29 1900 MAIN AVE SW, CULLMAN, AL, 350557200, US 1900 MAIN AVE SW, CULLMAN, AL, 350557200, US

Contacts
Phone +1 256-734-3759
Fax 2567349764

Authorized person
Name DR. LISA KAREN JOINES
Role OWNER/PHYSICIAN
Phone 2567343759

Taxonomy
Taxonomy Code 173000000X - Legal Medicine
License Number MD.23029
State AL
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 529916230
State AL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
ABC PEDIATRIC CLINIC SAFE HARBOR 401K 2016 061696129 2017-07-18 ABC PEDIATRIC CLINIC LLC 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 2567343759
Plan sponsor’s address 1900 MAIN AVE SW STE 4, CULLMAN, AL, 350557201

Signature of
Role Plan administrator
Date 2017-07-18
Name of individual signing LISA JOINES MD
ABC PEDIATRIC CLINIC SAFE HARBOR 401K 2015 061696129 2016-08-30 ABC PEDIATRIC CLINIC LLC 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 2567343759
Plan sponsor’s address 1900 MAIN AVE SW STE 4, CULLMAN, AL, 350557201

Signature of
Role Plan administrator
Date 2016-08-30
Name of individual signing LISA JOINES MD
ABC PEDIATRIC CLINIC SAFE HARBOR 401K 2014 061696129 2015-07-29 ABC PEDIATRIC CLINIC LLC 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 2567343759
Plan sponsor’s address 1900 MAIN AVENUE SW, CULLMAN, AL, 35055

Signature of
Role Plan administrator
Date 2015-07-29
Name of individual signing LISA JOINES MD
Role Employer/plan sponsor
Date 2015-07-29
Name of individual signing LISA JOINES MD
ABC PEDIATRIC CLINIC SAFE HARBOR 401K 2013 061696129 2014-09-20 ABC PEDIATRIC CLINIC LLC 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 2567343759
Plan sponsor’s address 1900 MAIN AVENUE SW, CULLMAN, AL, 35055

Signature of
Role Plan administrator
Date 2014-09-20
Name of individual signing LISA JOINES MD
ABC PEDIATRIC CLINIC SAFE HARBOR 401K 2012 061696129 2013-10-11 ABC PEDIATRIC CLINIC LLC 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 2567343759
Plan sponsor’s mailing address 1900 MAIN AVENUE SW, CULLMAN, AL, 35055
Plan sponsor’s address 1900 MAIN AVENUE SW, CULLMAN, AL, 35055

Number of participants as of the end of the plan year
Active participants 2

Signature of
Role Plan administrator
Date 2013-10-11
Name of individual signing LISA JOINES MD
Valid signature Filed with authorized/valid electronic signature
ABC PEDIATRIC CLINIC SAFE HARBOR 401K 2011 061696129 2012-08-02 ABC PEDIATRIC CLINIC LLC 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-06-01
Business code 621111
Plan sponsor’s address 1900 MAIN AVENUE SW, CULLMAN, AL, 35055

Plan administrator’s name and address
Administrator’s EIN 061696129
Plan administrator’s name ABC PEDIATRIC CLINIC LLC
Plan administrator’s address 1900 MAIN AVENUE SW, CULLMAN, AL, 35055

Signature of
Role Plan administrator
Date 2012-08-02
Name of individual signing LISA JOINES MD
ABC PEDIATRIC CLINIC SAFE HARBOR 401K 2010 061696129 2011-10-11 ABC PEDIATRIC CLINIC LLC 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-06-01
Business code 621111
Sponsor’s telephone number 2567343759
Plan sponsor’s address 1900 MAIN AVENUE SW, CULLMAN, AL, 35055

Plan administrator’s name and address
Administrator’s EIN 061696129
Plan administrator’s name ABC PEDIATRIC CLINIC LLC
Plan administrator’s address 1900 MAIN AVENUE SW, CULLMAN, AL, 35055
Administrator’s telephone number 2567343759

Signature of
Role Plan administrator
Date 2011-10-11
Name of individual signing LISA JOINES MD

Agent

Name Role Address
STEWART, MARSENA Agent 1420 MAPLE DR NWCULLMAN, AL 35055

Member

Name Role
JOINES, LISA K Member

Related by officers

STEWART, MARSENA

James Properties, LLC

JOINES, LISA K

LRB, LLC

Related by address

CULLMAN, AL

The A. A. A. Pest Control, Inc. Alabama Feed Service, Inc. Alabama Poultry Supply Co., Inc. Benefield Brothers, Incorporated Bennett Tire Service, Inc. Brindlee Mountain Development Corporation Buchmann Tire & Retreading, Inc. Builders & Traders, Inc. Central Grocery Company of Cullman Incorporated W. C. Chapman Poultry and Produce, Inc.

1900 MAIN AVENUE SWCULLMAN, AL 35055

Clyde L. Holloway, M.D., P.A.

Date of last update: 15 Aug 2024

Sources: Alabama Secretary of State

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