| Name: | Tri-State Urology, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Dissolved |
| Date of registration: | 20 Oct 2015 (9 years ago) |
| Date of dissolution: | 12 Feb 2021 |
| Entity Number: | 000-347-279 |
| Register Number: | 000347279 |
| ZIP code: | 36330 |
| County: | Coffee |
| Place of Formation: | Houston County |
| Registered Office Street Address: | 101 E. BRUNSON ST. SUITE 101ENTERPRISE, AL 36330 |
| Authorized Capital: | 1000 @ $1.00 PV |
Activities
UROLOGICAL PRACTICE
HEALTH CARE &/0R CONSULTATIVE SERVICES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1336514389 | 2015-12-02 | 2015-12-02 | 4300 W MAIN ST, SUITE 102, DOTHAN, AL, 363051054, US | 4300 W MAIN ST, SUITE 102, DOTHAN, AL, 363051054, US | |||||||||||||||||||
|
|||||||||||||||||||||||
| Phone | +1 334-793-9564 |
| Fax | 3346718907 |
Authorized person
| Name | MRS. MELISSA W REEVES |
| Role | ADMINISTRATOR |
| Phone | 3347939564 |
Taxonomy
| Taxonomy Code | 208800000X - Urology Physician |
| License Number | 7831 |
| State | AL |
| Is Primary | Yes |
| CAGE number | Status | Type | Established | CAGE Update Date | CAGE Expiration | SAM Expiration | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 7TJ80 | Obsolete | Non-Manufacturer | 2017-03-06 | 2022-11-02 | 2022-11-01 | No data | |||||||||||||||
|
|||||||||||||||||||||
| POC | SHEILA HERRING |
| Phone | +1 334-340-2917 |
| Fax | +1 334-671-8907 |
| Address | 4300 W MAIN ST STE 102, DOTHAN, HOUSTON, AL, 36305 1306, UNITED STATES |
Ownership of Offeror Information
| Highest Level Owner | Information not Available |
|---|
| Immediate Level Owner | Information not Available |
|---|
| List of Offerors (0) | Information not Available |
|---|
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| TRI-STATE UROLOGY, P.C. PROFIT SHARING PLAN | 2016 | 475360544 | 2017-07-27 | TRI-STATE UROLOGY, P.C. | 0 | |||||||||||||
|
||||||||||||||||||
| Name | Role | Address |
|---|---|---|
| PELFREY, ROBERT J | Director | 4300 WEST MAIN STREET SUITE 102DOTHAN, AL 36305 |
| Name | Role | Address |
|---|---|---|
| CHAMBERS, JOE M | Incorporator | 291 NORTH OATES STREETDOTHAN, AL 36303 |
| Name | Role |
|---|---|
| PELFREY, ROBERT | Agent |
Date of last update: 03 Aug 2024
Sources: Alabama Secretary of State
