Search icon

Auburn Dermatology and Skin Cancer Center, LLC

Details

Name: Auburn Dermatology and Skin Cancer Center, LLC
Jurisdiction: Alabama
Legal type: Domestic Limited Liability Company
Status: Exists
Date of registration: 10 Dec 2003 (21 years ago)
Entity Number: 000-695-395
Register Number: 000695395
County: Montgomery
Place of Formation: Montgomery County
Registered Office Street Address: 425 S PERRY STMONTGOMERY, AL 36104
Registered Office Street Address ZIP Code: 36104

Activities PROPERTY MANAGEMENT/REAL/PERSONAL PROPERTY

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1215029053 2006-09-29 2008-04-20 785 N DEAN RD STE 400, AUBURN, AL, 368304034, US 785 N DEAN RD STE 400, AUBURN, AL, 368304034, US

Contacts

Phone +1 334-887-5060
Fax 3348874367

Authorized person

Name PATTY MAY
Role BILLING MANAGER
Phone 3348875060

Taxonomy

Taxonomy Code 207N00000X - Dermatology Physician
Is Primary Yes

Other Provider Identifiers

Issuer MEDICARE PROVIDER NUMBER
Number J950
State AL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
AUBURN DERMATOLOGY AND SKIN CANCER CENTER 401(K) PLAN 2023 200466044 2024-07-26 AUBURN DERMATOLOGY AND SKIN CANCER CENTER 7
File View Page
Three-digit plan number (PN) 101
Effective date of plan 2012-01-01
Business code 621399
Sponsor’s telephone number 3348875060
Plan sponsor’s address 2172 MOORES MILL ROAD, AUBURN, AL, 36830

Plan administrator’s name and address

Administrator’s EIN 621874769
Plan administrator’s name ADMINISTRATIVE GROUP, LLC DBA TAG RESOURCES
Plan administrator’s address 6501 DEANE HILL DRIVE, KNOXVILLE, TN, 37919
Administrator’s telephone number 8656701844

Signature of

Role Plan administrator
Date 2024-07-26
Name of individual signing TARA EVANS, FOR TAG RESOURCES
AUBURN DERMATOLOGY AND SKIN CANCER CENTER 401(K) PLAN 2022 200466044 2023-08-01 AUBURN DERMATOLOGY AND SKIN CANCER CENTER 11
File View Page
Three-digit plan number (PN) 101
Effective date of plan 2012-01-01
Business code 621399
Sponsor’s telephone number 3348875060
Plan sponsor’s address 2172 MOORES MILL ROAD, AUBURN, AL, 36830

Plan administrator’s name and address

Administrator’s EIN 621874769
Plan administrator’s name ADMINISTRATIVE GROUP, LLC DBA TAG RESOURCES
Plan administrator’s address 6501 DEANE HILL DRIVE, KNOXVILLE, TN, 37919
Administrator’s telephone number 8656701844

Signature of

Role Plan administrator
Date 2023-08-01
Name of individual signing TARA EVANS, FOR TAG RESOURCES

Agent

Name Role Address
HOLMES, RONA Agent 785 N DEAN RD STE 400AUBURN, AL 36830

Member

Name Role Address
HOLMES, RONA Member 785 N DEAN RD STE 400AUBURN, AL 36830

Date of last update: 15 Aug 2024

Sources: Alabama Secretary of State