| Name: | R. Frank Roberts, Jr., M.D., P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Dissolved |
| Date of registration: | 10 Oct 2001 (23 years ago) (Companies founded in October 2001) |
| Date of dissolution: | 30 Dec 2011 |
| Entity Number: | 000-219-174 |
| Register Number: | 000219174 |
| Historical Names: |
Roberts & Bellot General Surgery, P.C.
|
| Place of Formation: | Madison County |
| Principal Address: | HUNTSVILLE, AL |
| Registered Office Street Address: | 201 SIVLEY RD STE 410HUNTSVILLE, AL 25801 |
| Authorized Capital: | $1,000 |
Activities
PRACTICE MEDICINE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1306875133 | 2006-07-02 | 2008-08-04 | 201 SIVLEY RD SW STE 410, HUNTSVILLE, AL, 358015146, US | 201 SIVLEY RD SW STE 410, HUNTSVILLE, AL, 358015146, US | |||||||||||||||||||||||||||||||
|
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| Phone | +1 256-517-1522 |
| Fax | 2565342132 |
Authorized person
| Name | DR. R FRANK ROBERTS JR. |
| Role | PRESIDENT |
| Phone | 2565171522 |
Taxonomy
| Taxonomy Code | 208600000X - Surgery Physician |
| License Number | 12306 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | 51505249 |
| State | AL |
| Issuer | MEDICAID |
| Number | 529910640 |
| State | AL |
| Name | Role |
|---|---|
| ROBERTS, R FRANK JR | Agent |
| Name | Role |
|---|---|
| ROBERTS, R FRANK JR | Incorporator |
| Event Date | Event Type | Old Value | New Value |
|---|---|---|---|
| 2003-04-24 | Name Change | Roberts & Bellot General Surgery, P.C. | R. Frank Roberts, Jr., M.D., P.C. |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
