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Robert M. Pritchett, M.D., P.A.

Details

Name: Robert M. Pritchett, M.D., P.A.
Jurisdiction: Alabama
Legal type: Domestic Professional Association
Status: Dissolved
Date of registration: 29 Jan 1981 (44 years ago) (Companies founded in January 1981)
Date of dissolution: 29 Apr 2016
Entity Number: 000-064-461
Register Number: 000064461
ZIP code: 35205 (Companies in Jefferson, 35205)
County: Jefferson
Place of Formation: Jefferson County
Principal Address: 2661 10TH AVENUE SOUTHBIRMINGHAM, AL 35205

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1720124738 2007-01-29 2010-03-09 2700 10TH AVE S, SUITE 400, BIRMINGHAM, AL, 352051200, US 2700 10TH AVE S, SUITE 400, BIRMINGHAM, AL, 352051200, US

Contacts
Phone +1 205-933-7710
Fax 2059338685

Authorized person
Name ROBERT PRITCHETT
Role PRESIDENT
Phone 2059337710

Taxonomy
Taxonomy Code 207N00000X - Dermatology Physician
License Number 7094
State AL
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 45156
State AL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
ROBERT M. PRITCHETT, M.D., P.A. 401(K) PROFIT SHARING PLAN 2015 630792685 2016-07-06 ROBERT M. PRITCHETT, M.D., P.A. 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1980-07-01
Business code 621111
Sponsor’s telephone number 2059337710
Plan sponsor’s address 4008 OLD LEEDS RIDGE, BIRMINGHAM, AL, 352133216

Signature of
Role Plan administrator
Date 2016-07-06
Name of individual signing ROBERT M. PRITCHETT, M.D.
ROBERT M. PRITCHETT, M.D., P.A. 401(K) PROFIT SHARING PLAN 2014 630792685 2015-06-10 ROBERT M. PRITCHETT, M.D., P.A. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1980-07-01
Business code 621111
Sponsor’s telephone number 2059337710
Plan sponsor’s address 2700 10TH AVENUE S, POB 2, STE 400, BIRMINGHAM, AL, 352051603

Signature of
Role Plan administrator
Date 2015-06-10
Name of individual signing ROBERT M. PRITCHETT, M.D.
ROBERT M. PRITCHETT, M.D., P.A. 401(K) PROFIT SHARING PLAN 2013 630792685 2014-07-08 ROBERT M. PRITCHETT, M.D., P.A. 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1980-07-01
Business code 621111
Sponsor’s telephone number 2059337710
Plan sponsor’s address 2700 10TH AVENUE S, POB 2, STE 400, BIRMINGHAM, AL, 352051603

Signature of
Role Plan administrator
Date 2014-07-08
Name of individual signing ROBERT M. PRITCHETT, M.D.
ROBERT M. PRITCHETT, M.D., P.A. 401(K) PROFIT SHARING PLAN 2012 630792685 2013-06-20 ROBERT M. PRITCHETT, M.D., P.A. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1980-07-01
Business code 621111
Sponsor’s telephone number 2059337710
Plan sponsor’s address 2700 10TH AVENUE SOUTH, POB 2, SUITE 400, BIRMINGHAM, AL, 352051603

Signature of
Role Plan administrator
Date 2013-06-20
Name of individual signing ROBERT M. PRITCHETT, M.D.
ROBERT M. PRITCHETT, M .D., P .A. 401(K) PROFIT SHARING PLAN 2011 630792685 2012-11-21 ROBERT M. PRITCHETT, M .D., P. A. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1980-07-01
Business code 621111
Sponsor’s telephone number 2059337710
Plan sponsor’s address 2700 10TH AVENUE SOUTH, POB 2, SUITE 400, BIRMINGHAM, AL, 352051603

Plan administrator’s name and address
Administrator’s EIN 630792685
Plan administrator’s name ROBERT M. PRITCHETT, M .D., P. A.
Plan administrator’s address 2700 10TH AVENUE SOUTH, POB 2, SUITE 400, BIRMINGHAM, AL, 352051603
Administrator’s telephone number 2059337710

Signature of
Role Plan administrator
Date 2012-11-21
Name of individual signing ROBERT M. PRITCHETT, M.D.
Role Employer/plan sponsor
Date 2012-11-21
Name of individual signing ROBERT M. PRITCHETT, M.D.
ROBERT M. PRITCHETT, M .D., P .A. 401(K) PROFIT SHARING PLAN 2010 630792685 2011-11-22 ROBERT M. PRITCHETT, M .D., P. A. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1980-07-01
Business code 621111
Sponsor’s telephone number 2059337710
Plan sponsor’s address 2700 10TH AVENUE SOUTH, POB 2, SUITE 400, BIRMINGHAM, AL, 352051603

Plan administrator’s name and address
Administrator’s EIN 630792685
Plan administrator’s name ROBERT M. PRITCHETT, M .D., P. A.
Plan administrator’s address 2700 10TH AVENUE SOUTH, POB 2, SUITE 400, BIRMINGHAM, AL, 352051603
Administrator’s telephone number 2059337710

Signature of
Role Plan administrator
Date 2011-11-22
Name of individual signing ROBERT M. PRITCHETT, M.D.
Role Employer/plan sponsor
Date 2011-11-22
Name of individual signing ROBERT M. PRITCHETT, M.D.
ROBERT M. PRITCHETT, M .D., P .A. MONEY PURCHASE PENSION PLAN 2009 630792685 2010-10-06 ROBERT M. PRITCHETT, M .D., P. A. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1980-07-01
Business code 621111
Sponsor’s telephone number 2059337710
Plan sponsor’s address 2700 10TH AVENUE SOUTH, POB 2, SUITE 400, BIRMINGHAM, AL, 352051603

Plan administrator’s name and address
Administrator’s EIN 630792685
Plan administrator’s name ROBERT M. PRITCHETT, M .D., P. A.
Plan administrator’s address 2700 10TH AVENUE SOUTH, POB 2, SUITE 400, BIRMINGHAM, AL, 352051603
Administrator’s telephone number 2059337710

Signature of
Role Plan administrator
Date 2010-10-06
Name of individual signing ROBERT M. PRITCHETT, M.D.
Role Employer/plan sponsor
Date 2010-10-06
Name of individual signing ROBERT M. PRITCHETT, M.D.

Member

Name Role
PRITCHETT, ROBERT M MD Member

Related by officers

No related officers

Related by address

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Date of last update: 31 Jul 2024

Sources: Alabama Secretary of State

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