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  5. Decatur Orthopaedic Clinic, LLC

Decatur Orthopaedic Clinic, LLC

Details

Name: Decatur Orthopaedic Clinic, LLC
Jurisdiction: Alabama
Legal type: Domestic Limited Liability Company
Status: Exists
Date of registration: 18 Jun 2012 (13 years ago)
Entity Number: 000-063-835
Register Number: 000063835
ZIP code: 35601
County: Morgan
Place of Formation: Morgan County
Registered Office Street Address: 1103 16TH AVENUE SOUTHEASTDECATUR, AL 35601

Activities OWN AND OPERATE A MEDICAL PRACTICE

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1740331347 2007-01-12 2024-02-09 1107 14TH AVE SE STE 300, DECATUR, AL, 356013368, US 1107 14TH AVE SE STE 300, DECATUR, AL, 356013368, US

Contacts
Phone +1 256-350-0362
Fax 2563559779

Authorized person
Name MARSHA B BUCHANAN
Role OFFICE MANAGER
Phone 2563500362

Taxonomy
Taxonomy Code 207X00000X - Orthopaedic Surgery Physician
Is Primary Yes
Taxonomy Code 207XX0004X - Orthopaedic Foot and Ankle Surgery Physician
Is Primary No
Taxonomy Code 207XX0005X - Sports Medicine (Orthopaedic Surgery) Physician
Is Primary No
Taxonomy Code 208100000X - Physical Medicine & Rehabilitation Physician
Is Primary No
Taxonomy Code 213ES0103X - Foot & Ankle Surgery Podiatrist
Is Primary No
Taxonomy Code 2251X0800X - Orthopedic Physical Therapist
Is Primary No
Taxonomy Code 332B00000X - Durable Medical Equipment & Medical Supplies
Is Primary No
Taxonomy Code 335E00000X - Prosthetic/Orthotic Supplier
Is Primary No

Other Provider Identifiers
Issuer MEDICAID
Number 528600740
State AL
Issuer MEDICARE RAILROAD
Number CH5919
State AL
Issuer ALABAMA MEDICAID DME
Number 009932533
State AL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
DECATUR ORTHOPAEDIC CLINIC, LLC CASH BALANCE PLAN 2023 630799912 2024-07-11 DECATUR ORTHOPAEDIC CLINIC 55
File View Page
Three-digit plan number (PN) 004
Effective date of plan 2018-01-01
Business code 621111
Sponsor’s telephone number 2563500362
Plan sponsor’s address 1103 16TH AVENUE SE, DECATUR, AL, 35601

Signature of
Role Plan administrator
Date 2024-07-11
Name of individual signing SCOTT SHARP
DECATUR ORTHOPAEDIC CLINIC, LLC 401(K) PLAN 2023 630799912 2024-07-11 DECATUR ORTHOPAEDIC CLINIC 62
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2004-04-01
Business code 621111
Sponsor’s telephone number 2563500362
Plan sponsor’s address 1107 14TH AVE SE STE300, DECATUR, AL, 35601

Signature of
Role Plan administrator
Date 2024-07-11
Name of individual signing SCOTT SHARP
DECATUR ORTHOPAEDIC CLINIC, LLC CASH BALANCE PLAN 2022 630799912 2023-07-19 DECATUR ORTHOPAEDIC CLINIC 53
File View Page
Three-digit plan number (PN) 004
Effective date of plan 2018-01-01
Business code 621111
Sponsor’s telephone number 2563500362
Plan sponsor’s address 1107 14TH AVE SE STE 300, DECATUR, AL, 35601

Signature of
Role Plan administrator
Date 2023-07-19
Name of individual signing SCOTT SHARP
DECATUR ORTHOPAEDIC CLINIC, LLC 401(K) PLAN 2022 630799912 2023-07-19 DECATUR ORTHOPAEDIC CLINIC 56
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2004-04-01
Business code 621111
Sponsor’s telephone number 2563500362
Plan sponsor’s address 1107 14TH AVE SE STE 300, DECATUR, AL, 35601

Signature of
Role Plan administrator
Date 2023-07-19
Name of individual signing SCOTT SHARP
DECATUR ORTHOPAEDIC CLINIC, LLC CASH BALANCE PLAN 2021 630799912 2022-10-07 DECATUR ORTHOPAEDIC CLINIC 48
File View Page
Three-digit plan number (PN) 004
Effective date of plan 2018-01-01
Business code 621111
Sponsor’s telephone number 2563500362
Plan sponsor’s address 1103 16TH AVENUE SE, DECATUR, AL, 35601

Signature of
Role Plan administrator
Date 2022-10-07
Name of individual signing SCOTT SHARP
DECATUR ORTHOPAEDIC CLINIC, LLC 401(K) PLAN 2021 630799912 2022-10-07 DECATUR ORTHOPAEDIC CLINIC, LLC 51
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2004-04-01
Business code 621111
Sponsor’s telephone number 2563500362
Plan sponsor’s address 1103 16TH AVENUE SE, DECATUR, AL, 35601

Signature of
Role Plan administrator
Date 2022-10-07
Name of individual signing SCOTT SHARP
DECATUR ORTHOPAEDIC CLINIC 401(K) PROFIT SHARING PLAN 2020 630799912 2021-10-07 DECATUR ORTHOPAEDIC CLINIC 49
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2004-04-01
Business code 621111
Sponsor’s telephone number 2563500362
Plan sponsor’s address 1103 16TH AVE SE, DECATUR, AL, 35601

Signature of
Role Plan administrator
Date 2021-10-07
Name of individual signing R. SCOTT SHARP, MD
DECATUR ORTHOPAEDIC CLINIC, LLC CASH BALANCE PLAN 2020 630799912 2021-10-07 DECATUR ORTHOPAEDIC CLINIC 49
File View Page
Three-digit plan number (PN) 004
Effective date of plan 2018-01-01
Business code 621111
Sponsor’s telephone number 2563500362
Plan sponsor’s address 1103 16TH AVE SE, DECATUR, AL, 35601

Signature of
Role Plan administrator
Date 2021-10-07
Name of individual signing R. SCOTT SHARP, MD
DECATUR ORTHOPAEDIC CLINIC, LLC CASH BALANCE PLAN 2019 630799912 2020-09-28 DECATUR ORTHOPAEDIC CLINIC 41
File View Page
Three-digit plan number (PN) 004
Effective date of plan 2018-01-01
Business code 621111
Sponsor’s telephone number 2563500362
Plan sponsor’s address 1103 16TH AVE SE, DECATUR, AL, 35601

Signature of
Role Plan administrator
Date 2020-09-28
Name of individual signing R. SCOTT SHARP, MD
DECATUR ORTHOPAEDIC CLINIC 401(K) PROFIT SHARING PLAN 2019 630799912 2020-09-28 DECATUR ORTHOPAEDIC CLINIC 50
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2004-04-01
Business code 621111
Sponsor’s telephone number 2563500362
Plan sponsor’s address 1103 16TH AVE SE, DECATUR, AL, 35601

Signature of
Role Plan administrator
Date 2020-09-28
Name of individual signing R. SCOTT SHARP, MD

Agent

Name Role Address
HOFAMMANN, DABNEY Y Agent 1103 16TH AVE SOUTHEASTDECATUR, AL 35601

Organizer

Name Role Address
HOFAMMANN, DABNEY Y Organizer 1103 16TH AVE SOUTHEASTDECATUR, AL 35601
SIMS, WILLIAM A Organizer 1103 16TH AVENUE SOUTHEASTDECATUR, AL 35601
TAPSCOTT, R STACY Organizer 1103 16TH AVENUE SOUTHEASTDECATUR, AL 35601
RIEHL, J RANDALL Organizer 1103 16TH AVENUE SOUTHEASTDECATUR, AL 35601
ELLIS, RUSSELL L Organizer 1103 16TH AVENUE SOUTHEASTDECATUR, AL 35601
SHARP, R SCOTT Organizer 1103 16TH AVENUE SOUTHEASTDECATUR, AL 35601
SIMONETTI, D J Organizer 420 20TH STREET N STE 1400BIRMINGHAM, AL 35203

Related by officers

HOFAMMANN, DABNEY Y

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SIMS, WILLIAM A

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TAPSCOTT, R STACY

DOC HOLDINGS, P.C. R. Stacy Tapscott, M.D., P.C. Byco Plastics, L.L.C. DOC Investments, L.L.C.

RIEHL, J RANDALL

DOC HOLDINGS, P.C. J. Randall Riehl, M.D., P.C. DOC Investments, L.L.C. Oceans Seven, L.L.C.

ELLIS, RUSSELL L

DOC HOLDINGS, P.C. DOC Investments, L.L.C.

SHARP, R SCOTT

DOC HOLDINGS, P.C. R. Scott Sharp, M.D., P.C. DOC Investments, L.L.C.

SIMONETTI, D J

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Related by address

No related companies by address

Date of last update: 31 Jul 2024

Sources: Alabama Secretary of State

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