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DERMATOLOGY CENTER OF LAKE CUMBERLAND, P.S.C.

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Company Details

Name: DERMATOLOGY CENTER OF LAKE CUMBERLAND, P.S.C.
Legal type: Kentucky Professional Services Corp
Status: Inactive
Standing: Good
Profit or Non-Profit: Profit
File Date: 03 Oct 1985 (40 years ago)
Organization Date: 03 Oct 1985 (40 years ago)
Last Annual Report: 03 Jun 2013 (12 years ago)
Organization Number: 0206754
ZIP code: 42503
City: Somerset
Primary County: Pulaski County
Principal Office: 120 B TRADE PARK DRIVE, SOMERSET, KY 42503
Place of Formation: KENTUCKY
Common No Par Shares: 1000

Shareholder

Name Role
Teresa Bentley Shareholder
Christopher Frost Shareholder
James Bentley Shareholder

Incorporator

Name Role
. Incorporator
TERESA J. BENTLEY, M.D. Incorporator

Director

Name Role
Teresa Bentley Director
TERESA J. BENTLEY, M.D. Director
JAMES R. BENTLEY Director
James Bentley Director
Christopher Frost Director

President

Name Role
Teresa Bentley President

Secretary

Name Role
James Bentley Secretary

Vice President

Name Role
Christopher Frost Vice President

Treasurer

Name Role
James Bentley Treasurer

Registered Agent

Name Role
TERESA J. BENTLEY, M.D. Registered Agent

National Provider Identifier

NPI Number:
1477639243

Authorized Person:

Name:
DR. TERESA BENTLEY
Role:
PHYSICIAN/OWNER
Phone:

Taxonomy:

Selected Taxonomy:
207NI0002X - Clinical & Laboratory Dermatological Immunology Physician
Is Primary:
No
Selected Taxonomy:
207ND0900X - Dermatopathology Physician
Is Primary:
No
Selected Taxonomy:
207ND0101X - MOHS-Micrographic Surgery Physician
Is Primary:
No
Selected Taxonomy:
363AM0700X - Medical Physician Assistant
Is Primary:
No
Selected Taxonomy:
207N00000X - Dermatology Physician
Is Primary:
Yes

Contacts:

Fax:
6066799294

Form 5500 Series

Employer Identification Number (EIN):
611084106
Plan Year:
2013
Number Of Participants:
17
Sponsors Telephone Number:
Plan Year:
2012
Number Of Participants:
23
Sponsors Telephone Number:
Plan Year:
2011
Number Of Participants:
21
Sponsors Telephone Number:
Plan Year:
2010
Number Of Participants:
21
Sponsors Telephone Number:
Plan Year:
2009
Number Of Participants:
21
Sponsors Telephone Number:

Former Company Names

Name Action
TERESA J. BENTLEY, M.D., P.S.C. Old Name

Filings

Name File Date
Dissolution 2013-12-10
Annual Report 2013-06-03
Annual Report 2012-05-24
Annual Report 2011-06-22
Annual Report 2010-06-16

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Sources: Kentucky Secretary of State