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  5. Decatur Physicians for Women, P.C.

Decatur Physicians for Women, P.C.

Details

Name: Decatur Physicians for Women, P.C.
Jurisdiction: Alabama
Legal type: Domestic Corporation
Status: Dissolved
Date of registration: 26 Jul 2004 (20 years ago)
Date of dissolution: 11 Dec 2012
Entity Number: 000-236-644
Register Number: 000236644
ZIP code: 35601
County: Morgan
Place of Formation: Morgan County
Principal Address: DECATUR, AL
Registered Office Street Address: 2114 BROOKMEADE RDDECATUR, AL 35601
Authorized Capital: $50

Activities RENDER PROFESSIONAL MEDICAL SERVICES

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1154434660 2006-08-17 2010-06-24 PO BOX 548, DECATUR, AL, 356020548, US 1874 BELTLINE RD SW, SUITE 300, DECATUR, AL, 356015514, US

Contacts
Phone +1 256-350-9700
Fax 2563509797

Authorized person
Name DR. LYNDA C GILLIAM
Role PRESIDENT
Phone 2563509700

Taxonomy
Taxonomy Code 207V00000X - Obstetrics & Gynecology Physician
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 529921630
State AL
Issuer MEDICARE PTAN
Number K234
State AL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
DECATUR PHYSICIANS FOR WOMEN PC 401(K) PROFIT SHARING PLAN 2012 810652870 2013-04-30 DECATUR PHYSICIANS FOR WOMEN 25
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-10-01
Business code 621111
Sponsor’s telephone number 2563557280
Plan sponsor’s address PO BOX 1562, DECATUR, AL, 35602

Plan administrator’s name and address
Administrator’s EIN 810652870
Plan administrator’s name DECATUR PHYSICIANS FOR WOMEN
Plan administrator’s address P O BOX 1562, DECATUR, AL, 35602
Administrator’s telephone number 2563557280

Signature of
Role Plan administrator
Date 2013-04-30
Name of individual signing LYNDA GILLIAM
Role Employer/plan sponsor
Date 2013-04-30
Name of individual signing LYNDA GILLIAM
DECATUR PHYSICIANS FOR WOMEN PC 401(K) PROFIT SHARING PLAN 2012 810652870 2013-04-29 DECATUR PHYSICIANS FOR WOMEN 25
Three-digit plan number (PN) 001
Effective date of plan 2006-10-01
Business code 621111
Sponsor’s telephone number 2563557280
Plan sponsor’s address PO BOX 1562, DECATUR, AL, 35602

Plan administrator’s name and address
Administrator’s EIN 810652870
Plan administrator’s name DECATUR PHYSICIANS FOR WOMEN
Plan administrator’s address P O BOX 1562, DECATUR, AL, 35602
Administrator’s telephone number 2563557280

Signature of
Role Plan administrator
Date 2013-04-17
Name of individual signing LYNDA GILLIAM
Role Employer/plan sponsor
Date 2013-04-17
Name of individual signing LYNDA GILLIAM
DECATUR PHYSICIANS FOR WOMEN PC 401(K) PROFIT SHARING PLAN 2011 810652870 2012-08-13 DECATUR PHYSICIANS FOR WOMEN 24
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-10-01
Business code 621111
Sponsor’s telephone number 2563557280
Plan sponsor’s address PO BOX 1562, DECATUR, AL, 35602

Plan administrator’s name and address
Administrator’s EIN 810652870
Plan administrator’s name DECATUR PHYSICIANS FOR WOMEN
Plan administrator’s address P O BOX 1562, DECATUR, AL, 35602
Administrator’s telephone number 2563557280

Signature of
Role Plan administrator
Date 2012-08-07
Name of individual signing CARA HOFFMAN
Role Employer/plan sponsor
Date 2012-08-07
Name of individual signing CARA HOFFMAN
DECATUR PHYSICIANS FOR WOMEN PC 401K PROFIT SHARING PLAN 2010 810652870 2011-07-27 DECATUR PHYSICIANS FOR WOMEN 25
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-10-01
Business code 621111
Sponsor’s telephone number 2563557280
Plan sponsor’s address PO BOX 1562, DECATUR, AL, 35602

Plan administrator’s name and address
Administrator’s EIN 810652870
Plan administrator’s name DECATUR PHYSICIANS FOR WOMEN
Plan administrator’s address P O BOX 1562, DECATUR, AL, 35602
Administrator’s telephone number 2563557280

Signature of
Role Plan administrator
Date 2011-07-27
Name of individual signing LYNDA GILLIAM
DECATUR PHYSICIANS FOR WOMEN PC 401K PROFIT SHARING PLAN 2009 810652870 2010-06-24 DECATUR PHYSICIANS FOR WOMEN 24
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-10-01
Business code 621111
Sponsor’s telephone number 2563557280
Plan sponsor’s address PO BOX 1562, DECATUR, AL, 35602

Plan administrator’s name and address
Administrator’s EIN 810652870
Plan administrator’s name DECATUR PHYSICIANS FOR WOMEN
Plan administrator’s address P O BOX 1562, DECATUR, AL, 35602
Administrator’s telephone number 2563557280

Signature of
Role Plan administrator
Date 2010-06-24
Name of individual signing LYNDA GILLIAM
Role Employer/plan sponsor
Date 2010-06-24
Name of individual signing LYNDA C GILLIAM

Agent

Name Role Address
GILLIAM, LYNDA C Agent 1617 PARK STREET SEDECATUR, AL 35601

Incorporator

Name Role Address
GILLIAM, LYNDA C Incorporator 1617 PARK STREET SEDECATUR, AL 35601

Related by officers

GILLIAM, LYNDA C

Oak Square, LLC

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Date of last update: 02 Aug 2024

Sources: Alabama Secretary of State

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