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DEREK E ROBINSON MD PC

Details

Name: DEREK E ROBINSON MD PC
Jurisdiction: Alabama
Legal type: Domestic Professional Corporation
Status: Exists
Date of registration: 27 Apr 1994 (31 years ago)
Entity Number: 000-163-870
Register Number: 000163870
Historical Names: E. Shields Frey, M.D. and Derek E Robinson, M.D., P.C.
Frey, Robinson & Tapscott, M.D.s, P.C.
County: Shelby
Place of Formation: Jefferson County
Registered Office Street Address: 1251 SPRING GARDEN STREETINDIAN SPRING, AL 35124
Registered Office Street Address ZIP Code: 35124
Authorized Capital: $100
Paid Share Capital: ----

Activities RENDER PROFESSIONAL MEDICAL SERVICES

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1265544860 2006-08-31 2013-09-10 860 MONTCLAIR RD STE 754, BIRMINGHAM, AL, 352131950, US 860 MONTCLAIR RD STE 754, BIRMINGHAM, AL, 352131950, US

Contacts
Phone +1 205-591-2565
Fax 2055915641

Authorized person
Name JAMES DRISKELL
Role CPA
Phone 2059860080

Taxonomy
Taxonomy Code 208600000X - Surgery Physician
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 529400610
State AL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
DEREK E ROBINSON MD PC PSP 2023 631068536 2024-09-13 DEREK E ROBINSON MD PC 1
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1993-01-01
Business code 621111
Sponsor’s telephone number 2059722565
Plan sponsor’s address 3686 GRANDVIEW PKWY STE 810, BIRMINGHAM, AL, 352433408
DEREK E ROBINSON MD PC PSP 2022 631068536 2023-10-13 DEREK E ROBINSON MD PC 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1993-01-01
Business code 621111
Sponsor’s telephone number 2059722565
Plan sponsor’s address 3686 GRANDVIEW PKWY STE 810, BIRMINGHAM, AL, 352433408
DEREK E ROBINSON MD PC PSP 2019 631068536 2020-10-12 DEREK E ROBINSON MD PC 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1993-01-01
Business code 621111
Sponsor’s telephone number 2059722565
Plan sponsor’s address 3686 GRANDVIEW PKWY STE 810, BIRMINGHAM, AL, 352433408
DEREK E ROBINSON MD PC PSP 2017 631068536 2018-10-09 DEREK E ROBINSON MD PC 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1993-01-01
Business code 621111
Sponsor’s telephone number 2059722565
Plan sponsor’s address 3686 GRANDVIEW PKWY STE 810, BIRMINGHAM, AL, 352433408
DEREK E ROBINSON MD PC PSP 2016 631068536 2017-10-10 DEREK E ROBINSON MD PC 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1993-01-01
Business code 621111
Sponsor’s telephone number 2059722565
Plan sponsor’s DBA name THE DRISKELL CPA FIRM PC
Plan sponsor’s address 3686 GRANDVIEW PKWY STE 810, BIRMINGHAM, AL, 352433408
DEREK E ROBINSON MD PC PSP 2014 631068536 2015-10-14 DEREK E ROBINSON MD PC 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1993-01-01
Business code 621111
Sponsor’s telephone number 2055912565
Plan sponsor’s address 3686 GRANDVIEW PKWY, STE 810, BIRMINGHAM, AL, 35243
DEREK E ROBINSON MD PC PSP 2013 631068536 2014-10-12 DEREK E ROBINSON MD PC 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1993-01-01
Business code 621111
Sponsor’s telephone number 2055912565
Plan sponsor’s address 840 MONTCLAIR RD, BIRMINGHAM, AL, 35213
E SHIELDS FREY & DEREK E ROBINSON MD PC PSP 2012 631068536 2013-10-14 DEREK E ROBINSON MD 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1993-01-01
Business code 621111
Sponsor’s telephone number 2055912565
Plan sponsor’s address 840 MONTCLAIR ROAD, BIRMIMGHAM, AL, 35213

Plan administrator’s name and address
Administrator’s EIN 631068536
Plan administrator’s name DEREK E ROBINSON MD
Plan administrator’s address 840 MONTCLAIR ROAD, BIRMIMGHAM, AL, 35213
Administrator’s telephone number 2055912565

Signature of
Role Plan administrator
Date 2013-10-14
Name of individual signing JAMES DRISKELL
E SHIELDS FREY & DEREK E ROBINSON MD PC PSP 2011 631068536 2012-10-04 DEREK E ROBINSON MD 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1993-01-01
Business code 621111
Sponsor’s telephone number 2055912565
Plan sponsor’s address 840 MONTCLAIR ROAD, BIRMIMGHAM, AL, 35213

Plan administrator’s name and address
Administrator’s EIN 631068536
Plan administrator’s name DEREK E ROBINSON MD
Plan administrator’s address 840 MONTCLAIR ROAD, BIRMIMGHAM, AL, 35213
Administrator’s telephone number 2055912565

Signature of
Role Plan administrator
Date 2012-10-04
Name of individual signing JAMES DRISKELL

Agent

Name Role
ROBINSON, DEREK E Agent

Incorporator

Name Role
ROBINSON, DEREK E MD Incorporator
FREY, E SHIELDS MD Incorporator

Events

Event Date Event Type Old Value New Value
2011-09-23 Name Change E. Shields Frey, M.D. and Derek E Robinson, M.D., P.C. DEREK E ROBINSON MD PC
2007-11-08 Name Change Frey, Robinson & Tapscott, M.D.s, P.C. E. Shields Frey, M.D. and Derek E Robinson, M.D., P.C.
2003-11-21 Name Change E. Shields Frey, M.D. and Derek E Robinson, M.D., P.C. Frey, Robinson & Tapscott, M.D.s, P.C.

Related by officers

FREY, E SHIELDS MD

E. Shields Frey, M.D., P.C.

Related by address

No related companies by address

Date of last update: 01 Aug 2024

Sources: Alabama Secretary of State

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