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