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  5. Fairbanks Urology, LLC

Fairbanks Urology, LLC

Contents

Company Details

Name: Fairbanks Urology, LLC
Jurisdiction: Alaska
Legal type: Limited Liability Company
Status: Good Standing
Date of registration: 06 Dec 2017 (7 years ago)
Entity Number: 10073118
ZIP code: 99701
County: Fairbanks North Star
Place of Formation: ALASKA
Address: 1211 CUSHMAN ST, FAIRBANKS, AK 99701
Mailing Address: 607 OLD STEESE HWY, STE B306, FAIRBANKS, AK 99701-6809

Activity

Line of Business

62 Health Care and Social Assistance

NAICS

621111 OFFICES OF PHYSICIANS (EXCEPT MENTAL HEALTH SPECIALISTS)

Officers

Name Role
Tony Nimeh Member
Tony Nimeh Registered Agent

Legal Entity Identifier

LEI number Registered As Jurisdiction Of Formation General Category Entity Status Entity created at
2549002QTYWR3FH3Y095 10073118 US-AK GENERAL ACTIVE -

Addresses
Legal Tony Nimeh, 607 Old Steese Hwy, Ste B306, Fairbanks, US-AK, US, 99701
Headquarters 2485 Chief William Drive, Fairbanks, US-AK, US, 99709

Registration details
Registration Date 2021-02-23
Last Update 2022-03-11
Status LAPSED
Next Renewal 2022-02-23
LEI Issuer 5493001KJTIIGC8Y1R12
Corroboration Level FULLY_CORROBORATED
Data Validated As 10073118

Form 5500

Plan Name Plan Year EIN/PN Received Total number of participants
FAIRBANKS UROLOGY, LLC 401(K) PROFIT SHARING PLAN AND TRUST 2022 823785749 2023-07-25 42
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2020-10-01
Sponsor FAIRBANKS UROLOGY, LLC
Business code 621111
Sponsor’s telephone number 9073280989
Plan sponsor’s address 607 OLD STEESE HIGHWAY, SUITE B306, FAIRBANKS, AK, 99701

Signature of
Role Plan administrator
Date 2023-07-25
Name of individual signing TONY NIMEH
Role Employer/plan sponsor
Date 2023-07-25
Name of individual signing TONY NIMEH
FAIRBANKS UROLOGY, LLC 401(K) PROFIT SHARING PLAN AND TRUST 2022 823785749 2023-05-24 43
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2020-10-01
Sponsor FAIRBANKS UROLOGY, LLC
Business code 621111
Sponsor’s telephone number 9073280989
Plan sponsor’s address 607 OLD STEESE HIGHWAY, SUITE B306, FAIRBANKS, AK, 99701

Signature of
Role Plan administrator
Date 2023-05-24
Name of individual signing TONY NIMEH
Role Employer/plan sponsor
Date 2023-05-24
Name of individual signing TONY NIMEH
FAIRBANKS UROLOGY, LLC 401(K) PROFIT SHARING PLAN AND TRUST 2021 823785749 2022-07-26 21
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2020-10-01
Sponsor FAIRBANKS UROLOGY, LLC
Business code 621111
Sponsor’s telephone number 9073280989
Plan sponsor’s address 607 OLD STEESE HIGHWAY, SUITE B306, FAIRBANKS, AK, 99701

Signature of
Role Plan administrator
Date 2022-07-26
Name of individual signing TONY NIMEH
Role Employer/plan sponsor
Date 2022-07-26
Name of individual signing TONY NIMEH
FAIRBANKS UROLOGY, LLC 401(K) PROFIT SHARING PLAN AND TRUST 2020 823785749 2021-09-29 0
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2020-10-01
Sponsor FAIRBANKS UROLOGY, LLC
Business code 621111
Sponsor’s telephone number 9073280989
Plan sponsor’s address 607 OLD STEESE HIGHWAY, SUITE B306, FAIRBANKS, AK, 99701

Signature of
Role Plan administrator
Date 2021-09-29
Name of individual signing TONY NIMEH
Role Employer/plan sponsor
Date 2021-09-29
Name of individual signing TONY NIMEH

Licenses

Type License Number Status Date of issue Date of renewal Expiration date Description
Business License 1065665 Active 2018-01-08 2023-10-18 2024-12-31 LOB: 62 - Health Care and Social Assistance, NAICS: 621111 - OFFICES OF PHYSICIANS (EXCEPT MENTAL HEALTH SPECIALISTS)
Telemedicine Business Registry 159009 Active 2020-03-18 - - -

Date of last update: 11 Jan 2025

Sources: State of Alaska - Department of Commerce, Community, and Economic Development

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