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Mobile Surgical Services, PC

Details

Name: Mobile Surgical Services, PC
Jurisdiction: Alabama
Legal type: Domestic Professional Corporation
Status: Dissolved
Date of registration: 02 Jun 1987 (37 years ago)
Date of dissolution: 22 Dec 2015
Entity Number: 000-117-652
Register Number: 000117652
Historical Names: Lightfoot & Lightfoot Surgery, P.C.
County: Mobile
Place of Formation: Mobile County
Registered Office Street Address: 3401 MEDICAL PARK DRIVE, STE 102MOBILE, AL 36609
Registered Office Street Address ZIP Code: 36609
Authorized Capital: $10,000
Paid Share Capital: $1,000

Activities PRACTICE OF MEDICINE

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1558382671 2006-07-22 2008-12-17 6701 AIRPORT BLVD, SUITE D231, MOBILE, AL, 366086705, US 6701 AIRPORT BLVD, SUITE D231, MOBILE, AL, 366086705, US

Contacts
Phone +1 251-633-4064
Fax 2516330122

Authorized person
Name WILLIAM MALCOLM LIGHTFOOT
Role PRESIDENT
Phone 2516334064

Taxonomy
Taxonomy Code 208600000X - Surgery Physician
License Number 00006907
State AL
Is Primary Yes
Taxonomy Code 208600000X - Surgery Physician
License Number 00026047
State AL
Is Primary No

Other Provider Identifiers
Issuer BCBS-RFH
Number 51523580
State AL
Issuer UNITED HEALTHCARE-WML
Number 1710151
State AL
Issuer BCBS-WML
Number 51006999
State AL
Issuer MEDICAID
Number HW0099964115
State AL
Issuer MEDICAID
Number LI000006999
State AL
Issuer RAILROAD MEDICARE-RFH
Number P00157802
State AL
Issuer UNITED HEALTHCARE-RFH
Number 3700108
State AL
Issuer RAILROAD MEDICARE-WML
Number 020038001
State AL
Issuer RAILROAD MEDICARE-GROUP
Number CI2733
State AL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
MOBILE SURGICAL SERVICES, PC PROFIT SHARING PLAN 2014 630956173 2015-10-15 MOBILE SURGICAL SERVICES, PC 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1989-01-01
Business code 621111
Sponsor’s telephone number 2516334064
Plan sponsor’s address 6701 AIRPORT BLVD., SUITE B-222, MOBILE, AL, 36608
MOBILE SURGICAL SERVICES, PC PROFIT SHARING PLAN 2013 630956173 2014-10-09 MOBILE SURGICAL SERVICES, PC 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1989-01-01
Business code 621111
Sponsor’s telephone number 2516334064
Plan sponsor’s address 6701 AIRPORT BLVD., SUITE B-222, MOBILE, AL, 36608

Signature of
Role Plan administrator
Date 2014-10-09
Name of individual signing WILLIAM M. LIGHTFOOT
MOBILE SURGICAL SERVICES, PC PROFIT SHARING PLAN 2012 630956173 2013-10-15 MOBILE SURGICAL SERVICES, PC 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1989-01-01
Business code 621111
Sponsor’s telephone number 2516334064
Plan sponsor’s address 6701 AIRPORT BLVD., SUITE D-231, MOBILE, AL, 36608

Signature of
Role Plan administrator
Date 2013-10-15
Name of individual signing WILLIAM M. LIGHTFOOT
MOBILE SURGICAL SERVICES, PC PROFIT SHARING PLAN 2011 630956173 2012-10-12 MOBILE SURGICAL SERVICES, PC 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1989-01-01
Business code 621111
Sponsor’s telephone number 2516334064
Plan sponsor’s address 6701 AIRPORT BLVD., SUITE D-231, MOBILE, AL, 36608

Plan administrator’s name and address
Administrator’s EIN 630956173
Plan administrator’s name MOBILE SURGICAL SERVICES, PC
Plan administrator’s address 6701 AIRPORT BLVD., SUITE D-231, MOBILE, AL, 36608
Administrator’s telephone number 2516334064

Signature of
Role Plan administrator
Date 2012-10-12
Name of individual signing WILLIAM M. LIGHTFOOT
MOBILE SURGICAL SERVICES, PC PROFIT SHARING PLAN 2010 630956173 2011-03-31 MOBILE SURGICAL SERVICES, PC 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1989-01-01
Business code 621111
Sponsor’s telephone number 2516334064
Plan sponsor’s address 6701 AIRPORT BLVD., SUITE D-231, MOBILE, AL, 36608

Plan administrator’s name and address
Administrator’s EIN 630956173
Plan administrator’s name MOBILE SURGICAL SERVICES, PC
Plan administrator’s address 6701 AIRPORT BLVD., SUITE D-231, MOBILE, AL, 36608
Administrator’s telephone number 2516334064

Signature of
Role Plan administrator
Date 2011-03-31
Name of individual signing WILLIAM M. LIGHTFOOT
MOBILE SURGICAL SERVICES, PC PROFIT SHARING PLAN 2009 630956173 2010-10-14 MOBILE SURGICAL SERVICES, PC 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1989-01-01
Business code 621111
Sponsor’s telephone number 2516334064
Plan sponsor’s address 6701 AIRPORT BLVD., SUITE D-231, MOBILE, AL, 36608

Plan administrator’s name and address
Administrator’s EIN 630956173
Plan administrator’s name MOBILE SURGICAL SERVICES, PC
Plan administrator’s address 6701 AIRPORT BLVD., SUITE D-231, MOBILE, AL, 36608
Administrator’s telephone number 2516334064

Signature of
Role Plan administrator
Date 2010-10-14
Name of individual signing WILLIAM M. LIGHTFOOT

Agent

Name Role
LIGHTFOOT, WILLIAM M MD Agent

Incorporator

Name Role
LIGHTFOOT, WILLIAM M MD Incorporator
LIGHTFOOT, ROBERT D MD Incorporator

Events

Event Date Event Type Old Value New Value
2004-05-11 Name Change Lightfoot & Lightfoot Surgery, P.C. Mobile Surgical Services, PC

Related by officers

No related officers

Related by address

No related companies by address

Date of last update: 31 Jul 2024

Sources: Alabama Secretary of State

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