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  5. Plastic Surgery of Tuscaloosa, Inc.

Plastic Surgery of Tuscaloosa, Inc.

Details

Name: Plastic Surgery of Tuscaloosa, Inc.
Jurisdiction: Alabama
Legal type: Domestic Professional Corporation
Status: Exists
Date of registration: 24 Jan 1990 (35 years ago)
Entity Number: 000-135-237
Register Number: 000135237
Historical Names: John W. Menard, M.D., P.C.
Plastic Surgery, Inc.
ZIP code: 36104
County: Montgomery
Place of Formation: Tuscaloosa County
Principal Address: TUSCALOOSA, AL
Registered Office Street Address: 2 NORTH JACKSON STREET, SUITE 605MONTGOMERY, AL 36104
Authorized Capital: $5,000

Activities PLASTIC SURGERY

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1316014681 2006-11-29 2023-10-03 1847 COMMONS NORTH DR STE A, TUSCALOOSA, AL, 354063700, US 1847 COMMONS NORTH DR STE A, TUSCALOOSA, AL, 354063700, US

Contacts
Phone +1 205-349-0049
Fax 6597342003

Authorized person
Name MARQUIS HESTER
Role INSURANCE
Phone 2053490049

Taxonomy
Taxonomy Code 2086S0122X - Plastic and Reconstructive Surgery Physician
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 529900080
State AL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
PLASTIC SURGERY OF TUSCALOOSA 401(K) SAVINGS PLAN 2019 631014137 2020-10-08 PLASTIC SURGERY OF TUSCALOOSA, INC. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 2053490049
Plan sponsor’s address 1847 COMMONS NORTH DRIVE, TUSCALOOSA, AL, 35406
PLASTIC SURGERY OF TUSCALOOSA 401(K) SAVINGS PLAN 2019 631014137 2020-10-08 PLASTIC SURGERY OF TUSCALOOSA, INC. 17
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 2053490049
Plan sponsor’s address 1847 COMMONS NORTH DRIVE, TUSCALOOSA, AL, 35406
PLASTIC SURGERY OF TUSCALOOSA 401(K) SAVINGS PLAN 2018 631014137 2019-10-03 PLASTIC SURGERY OF TUSCALOOSA, INC. 23
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 2053490049
Plan sponsor’s address 1847 COMMONS NORTH DRIVE, TUSCALOOSA, AL, 35406
PLASTIC SURGERY OF TUSCALOOSA 401(K) SAVINGS PLAN 2017 631014137 2018-10-11 PLASTIC SURGERY OF TUSCALOOSA, INC. 23
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 2053490049
Plan sponsor’s address 1847 COMMONS NORTH DRIVE, TUSCALOOSA, AL, 35406
PLASTIC SURGERY OF TUSCALOOSA 401(K) SAVINGS PLAN 2016 631014137 2017-09-22 PLASTIC SURGERY OF TUSCALOOSA, INC. 24
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 2053490049
Plan sponsor’s address 1847 COMMONS NORTH DRIVE, TUSCALOOSA, AL, 35406
PLASTIC SURGERY OF TUSCALOOSA 401(K) SAVINGS PLAN 2015 631014137 2016-09-02 PLASTIC SURGERY OF TUSCALOOSA, INC. 26
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 2053490049
Plan sponsor’s address 1847 COMMONS NORTH DRIVE, TUSCALOOSA, AL, 35406
PLASTIC SURGERY OF TUSCALOOSA 401(K) SAVINGS PLAN 2014 631014137 2015-09-22 PLASTIC SURGERY OF TUSCALOOSA, INC. 22
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 2053490049
Plan sponsor’s address 1847 COMMONS NORTH DRIVE, TUSCALOOSA, AL, 35406

Signature of
Role Plan administrator
Date 2015-09-22
Name of individual signing KAY DAY
PLASTIC SURGERY OF TUSCALOOSA 401(K) SAVINGS PLAN 2013 631014137 2014-10-09 PLASTIC SURGERY OF TUSCALOOSA, INC. 22
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 2053490049
Plan sponsor’s address 1847 COMMONS NORTH DRIVE, TUSCALOOSA, AL, 35406

Signature of
Role Plan administrator
Date 2014-10-09
Name of individual signing KAY DAY
PLASTIC SURGERY OF TUSCALOOSA 401(K) SAVINGS PLAN 2012 631014137 2013-07-31 PLASTIC SURGERY OF TUSCALOOSA, INC. 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 2053919038
Plan sponsor’s address 1847 COMMONS NORTH DRIVE, TUSCALOOSA, AL, 35406

Signature of
Role Plan administrator
Date 2013-07-31
Name of individual signing KAY A DAY
Role Employer/plan sponsor
Date 2013-07-31
Name of individual signing ROSS E BUNCH, M.D.
PLASTIC SURGERY OF TUSCALOOSA 401(K) SAVINGS PLAN 2011 631014137 2012-10-12 PLASTIC SURGERY OF TUSCALOOSA, INC. 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 2053919038
Plan sponsor’s address 1847 COMMONS NORTH DRIVE, TUSCALOOSA, AL, 35406

Plan administrator’s name and address
Administrator’s EIN 631014137
Plan administrator’s name PLASTIC SURGERY OF TUSCALOOSA, INC.
Plan administrator’s address 1847 COMMONS NORTH DRIVE, TUSCALOOSA, AL, 35406
Administrator’s telephone number 2053919038

Signature of
Role Plan administrator
Date 2012-10-12
Name of individual signing ROSS BUNCH

Agent

Name Role Address
C T CORPORATION SYSTEM Agent 2 NORHT JACKSON STREET SUITE 605MONTGOMERY, AL 36104

Incorporator

Name Role
MENARD, JOHN W MD Incorporator

Events

Event Date Event Type Old Value New Value
2009-07-07 Name Change Plastic Surgery, Inc. Plastic Surgery of Tuscaloosa, Inc.
1996-12-17 Name Change John W. Menard, M.D., P.C. Plastic Surgery, Inc.

Related by officers

C T CORPORATION SYSTEM

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2 NORTH JACKSON STREET, SUITE 605MONTGOMERY, AL 36104

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Date of last update: 01 Aug 2024

Sources: Alabama Secretary of State

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