| Name: | Lakeside North Family Medicine, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Series Limited Liability Company |
| Status: | Exists |
| Date of registration: | 03 Jun 2021 (3 years ago) (Companies founded in June 2021) |
| Entity Number: | 000-865-492 |
| Register Number: | 000865492 |
| ZIP code: | 35976 (Companies in Marshall, 35976) |
| County: | Marshall |
| Place of Formation: | Marshall County |
| Registered Office Street Address: | 38 ROWE DRGUNTERSVILLE, AL 35976 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1891430583 | 2022-04-28 | 2022-04-28 | 38 ROWE DR, GUNTERSVILLE, AL, 359767367, US | 38 ROWE DR, GUNTERSVILLE, AL, 359767367, US | |||||||||||||||
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| Phone | +1 256-571-8460 |
| Fax | 2565718464 |
Authorized person
| Name | DAVID CLAY CAMPBELL |
| Role | PRESIDENT |
| Phone | 2565718460 |
Taxonomy
| Taxonomy Code | 261QR1300X - Rural Health Clinic/Center |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| LAKESIDE NORTH 401(K) PLAN | 2023 | 863806691 | 2024-06-14 | LAKESIDE NORTH FAMILY MEDICINE, LLC | 21 | |||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2024-06-14 |
| Name of individual signing | JESSICA CAMPBELL |
| File | View Page |
| Three-digit plan number (PN) | 002 |
| Effective date of plan | 2019-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 2565718460 |
| Plan sponsor’s address | 38 ROWE DRIVE, GUNTERSVILLE, AL, 35976 |
| File | View Page |
| Three-digit plan number (PN) | 002 |
| Effective date of plan | 2019-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 2565718460 |
| Plan sponsor’s address | 38 ROWE DRIVE, GUNTERSVILLE, AL, 35976 |
Signature of
| Role | Plan administrator |
| Date | 2022-06-13 |
| Name of individual signing | NAKITA MEREDITH |
| Name | Role | Address |
|---|---|---|
| DAVID CAMPBELL | Agent | 38 ROWE DRGUNTERSVILLE, AL 35976 |
| Name | Role | Address |
|---|---|---|
| DAVID CAMPBELL | Organizer | 38 ROWE DRGUNTERSVILLE, AL 35976 |
Date of last update: 16 Aug 2024
Sources: Alabama Secretary of State
