Bay Street Clinic, LLC

Contacts

Phone	+1 256-546-1011
Fax	2564673294

Authorized person

Name	LAYLA WREN
Role	OWNER
Phone	2565461011

Taxonomy

Taxonomy Code	207Q00000X - Family Medicine Physician
Is Primary	Yes

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2021-01-01
Business code	621111
Sponsor’s telephone number	2565461011
Plan sponsor’s address	403 BAY STREET, GADSDEN, AL, 35901

Signature of

Role	Plan administrator
Date	2024-04-22
Name of individual signing	LAYLA WREN

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2021-01-01
Business code	621111
Sponsor’s telephone number	2565461011
Plan sponsor’s address	403 BAY ST, GADSDEN, AL, 359015107

Signature of

Role	Plan administrator
Date	2023-01-10
Name of individual signing	LAYLA WREN
Role	Employer/plan sponsor
Date	2023-01-10
Name of individual signing	LAYLA WREN

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2021-01-01
Business code	621111
Sponsor’s telephone number	2565461011
Plan sponsor’s address	403 BAY ST, GADSDEN, AL, 359015107

Signature of

Role	Plan administrator
Date	2022-01-12
Name of individual signing	LAYLA WREN
Role	Employer/plan sponsor
Date	2022-01-12
Name of individual signing	LAYLA WREN