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  5. Coastal Surgery, P.C.

Coastal Surgery, P.C.

Details

Name: Coastal Surgery, P.C.
Jurisdiction: Alabama
Legal type: Domestic Professional Corporation
Status: Dissolved
Date of registration: 27 Sep 1996 (28 years ago)
Date of dissolution: 28 Nov 2017
Entity Number: 000-182-661
Register Number: 000182661
Historical Names: Jeffrey L. Caylor, D.O., P.C.
ZIP code: 36535
County: Baldwin
Place of Formation: Baldwin County
Principal Address: FOLEY, AL
Registered Office Street Address: 815 N MCKENZIE ST STE CFOLEY, AL 36535
Authorized Capital: $5,000
Paid Share Capital: $2,500

Activities MEDICAL PRACTICE

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1538345681 2008-01-18 2011-03-10 PO BOX 2065, 1668 NORTH PINE STREET, FOLEY, AL, 365362065, US 1668 N PINE ST, FOLEY, AL, 365352220, US

Contacts
Phone +1 251-970-1948
Fax 2519701593

Authorized person
Name MRS. PAMELA DARLENE CHARLTON
Role ADMINISTRATOR
Phone 2519701948

Taxonomy
Taxonomy Code 208600000X - Surgery Physician
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 000026690
State AL
Issuer MEDICAID
Number 000099973
State AL
Issuer NPI
Number 1730153271
Issuer BCBS AL
Number 51026690
State AL
Issuer NPI
Number 1306842570
State AL
Issuer BCBS AL
Number 51002338
State AL
Issuer BCBS AL
Number 51099973
State AL
Issuer NPI
Number 1275506917
State AL
Issuer MEDICAID
Number 529925730
State AL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
COASTAL SURGERY 401(K) PROFIT SHARING PLAN 2016 631172152 2017-12-11 COASTAL SURGERY, P.C. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 2519701948
Plan sponsor’s address 7200 VIOLA RD, GULF SHORES, AL, 36542

Signature of
Role Plan administrator
Date 2017-12-11
Name of individual signing JEFFREY CAYLOR
COASTAL SURGERY 401(K) PROFIT SHARING PLAN 2016 631172152 2017-05-22 COASTAL SURGERY, P.C. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 2519787906
Plan sponsor’s address 7200 VIOLA ROAD, GULF SHORES, AL, 36542

Signature of
Role Plan administrator
Date 2017-05-22
Name of individual signing JEFFREY CAYLOR
COASTAL SURGERY 401(K) PROFIT SHARING PLAN 2015 631172152 2016-04-28 COASTAL SURGERY, P.C. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 2519701295
Plan sponsor’s address 1668 N PINE STREET, FOLEY, AL, 36535

Signature of
Role Plan administrator
Date 2016-04-28
Name of individual signing JEFFREY CAYLOR
COASTAL SURGERY 401(K) PROFIT SHARING PLAN 2014 631172152 2015-07-06 COASTAL SURGERY, P.C. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 2519701295
Plan sponsor’s address 1668 N PINE STREET, FOLEY, AL, 36535

Signature of
Role Plan administrator
Date 2015-07-06
Name of individual signing JEFFREY CAYLOR
COASTAL SURGERY 401(K) PROFIT SHARING PLAN 2013 631172152 2014-05-20 COASTAL SURGERY, P.C. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 2519701295
Plan sponsor’s address 1668 N PINE STREET, FOLEY, AL, 36535

Signature of
Role Plan administrator
Date 2014-05-20
Name of individual signing JEFFREY CAYLOR
COASTAL SURGERY 401(K) PROFIT SHARING PLAN 2012 631172152 2013-06-01 COASTAL SURGERY, P.C. 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 2519701295
Plan sponsor’s address 1668 N PINE STREET, FOLEY, AL, 36535

Signature of
Role Plan administrator
Date 2013-06-01
Name of individual signing JEFFREY CAYLOR
COASTAL SURGERY 401(K) PROFIT SHARING PLAN 2011 631172152 2012-07-03 COASTAL SURGERY, P.C. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 2519701295
Plan sponsor’s address 1668 N PINE STREET, FOLEY, AL, 36535

Plan administrator’s name and address
Administrator’s EIN 631172152
Plan administrator’s name COASTAL SURGERY, P.C.
Plan administrator’s address 1668 N PINE STREET, FOLEY, AL, 36535
Administrator’s telephone number 2519701295

Signature of
Role Plan administrator
Date 2012-07-03
Name of individual signing JEFFREY CAYLOR
COASTAL SURGERY 401(K) PROFIT SHARING PLAN 2010 631172152 2011-07-21 COASTAL SURGERY, P.C. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 2519701948
Plan sponsor’s address P.O. BOX 2065, FOLEY, AL, 36536

Plan administrator’s name and address
Administrator’s EIN 631172152
Plan administrator’s name COASTAL SURGERY, P.C.
Plan administrator’s address P.O. BOX 2065, FOLEY, AL, 36536
Administrator’s telephone number 2519701948

Signature of
Role Plan administrator
Date 2011-07-21
Name of individual signing JEFFREY CAYLOR
COASTAL SURGERY 401(K) PROFIT SHARING PLAN 2009 631172152 2010-07-28 COASTAL SURGERY, P.C. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 2519701948
Plan sponsor’s address P.O. BOX 2065, 1668 NORTH PINE STREET, FOLEY, AL, 36535

Plan administrator’s name and address
Administrator’s EIN 631172152
Plan administrator’s name COASTAL SURGERY, P.C.
Plan administrator’s address P.O. BOX 2065, 1668 NORTH PINE STREET, FOLEY, AL, 36535
Administrator’s telephone number 2519701948

Signature of
Role Plan administrator
Date 2010-07-28
Name of individual signing JEFFREY CAYLOR

Agent

Name Role
CAYLOR, JEFFREY L Agent

Incorporator

Name Role
CAYLOR, JEFFREY L Incorporator

Events

Event Date Event Type Old Value New Value
2004-04-06 Name Change Jeffrey L. Caylor, D.O., P.C. Coastal Surgery, P.C.

Related by officers

CAYLOR, JEFFREY L

Coastal Bariatrics, P.C. Providence Family Limited Partnership J & L, POB, L.L.C.

Related by address

FOLEY, AL

Baldwin Memorial Cemetery, Inc. Boller Petroleum, Inc. Roman J. Claprood Co. of Ala., Inc. Diversified Investors and Developers, Inc. Dixie Furniture Co., Inc. E-J Builders, Inc. Ebert Agency, Inc. Farmers & Merchants Bank Foley Dairy, Inc. Foley Hardware Company, Inc.

815 N MCKENZIE ST STE CFOLEY, AL 36535

Hyde's Roofing LLC

Date of last update: 01 Aug 2024

Sources: Alabama Secretary of State

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