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H. S. JACKSON, JR. P. S. C.

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Company Details

Name: H. S. JACKSON, JR. P. S. C.
Legal type: Kentucky Professional Services Corp
Status: Inactive
Standing: Bad
Profit or Non-Profit: Profit
File Date: 12 Apr 1972 (53 years ago)
Organization Date: 12 Apr 1972 (53 years ago)
Last Annual Report: 11 Apr 2016 (9 years ago)
Organization Number: 0025510
ZIP code: 42071
City: Murray
Primary County: Calloway County
Principal Office: 1522 CANTERBURY DR, MURRAY, KY 42071
Place of Formation: KENTUCKY
Common No Par Shares: 200

Registered Agent

Name Role
H. S. JACKSON, JR. Registered Agent

Sole Officer

Name Role
Herschel S Jackson Sole Officer

Director

Name Role
Herschel S Jackson Director

Shareholder

Name Role
Herschel S Jackson Shareholder

Incorporator

Name Role
H. S. JACKSON, JR. Incorporator

National Provider Identifier

NPI Number:
1538361118

Authorized Person:

Name:
HERSCHEL SWAN JACKSON JR.
Role:
PRESIDENT
Phone:

Taxonomy:

Selected Taxonomy:
363LF0000X - Family Nurse Practitioner
Is Primary:
No
Selected Taxonomy:
208800000X - Urology Physician
Is Primary:
Yes

Contacts:

Fax:
2707673629

Form 5500 Series

Employer Identification Number (EIN):
610724976
Plan Year:
2010
Number Of Participants:
2
Sponsors Telephone Number:
Plan Year:
2009
Number Of Participants:
2
Sponsors Telephone Number:

Filings

Name File Date
Administrative Dissolution 2017-10-09
Principal Office Address Change 2016-04-11
Registered Agent name/address change 2016-04-11
Annual Report 2016-04-11
Annual Report 2015-05-11

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Sources: Kentucky Secretary of State