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SPINE SURGERY, P.S.C.

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Company Details

Name: SPINE SURGERY, P.S.C.
Legal type: Kentucky Professional Services Corp
Status: Inactive
Standing: Good
Profit or Non-Profit: Profit
File Date: 30 Nov 1990 (35 years ago)
Organization Date: 30 Nov 1990 (35 years ago)
Last Annual Report: 16 May 2015 (10 years ago)
Organization Number: 0280005
ZIP code: 40059
City: Prospect, River Bluff
Primary County: Jefferson County
Principal Office: 12115 COVERED BRIDGE ROAD, PROSPECT, KY 40059
Place of Formation: KENTUCKY
Authorized Shares: 1000

Registered Agent

Name Role
RICHARD T. HOLT, M.D. Registered Agent

President

Name Role
RICHARD T HOLT President

Secretary

Name Role
SUE R HOLT Secretary

Director

Name Role
RICHARD T HOLT Director
RICHARD T. HOLT, M.D. Director

Shareholder

Name Role
RICHARD T HOLT Shareholder

Incorporator

Name Role
RICHARD T. HOLT, M.D. Incorporator

National Provider Identifier

NPI Number:
1447236237

Authorized Person:

Name:
MRS. LINETTE M GADWAH
Role:
CREDENTIALING COORDINATOR
Phone:

Taxonomy:

Selected Taxonomy:
207XS0117X - Orthopaedic Surgery of the Spine Physician
Is Primary:
Yes

Contacts:

Fax:
5025842726

Form 5500 Series

Employer Identification Number (EIN):
611190467
Plan Year:
2016
Number Of Participants:
2
Sponsors Telephone Number:
Plan Year:
2015
Number Of Participants:
3
Sponsors Telephone Number:
Plan Year:
2014
Number Of Participants:
3
Sponsors Telephone Number:
Plan Year:
2013
Number Of Participants:
15
Sponsors Telephone Number:
Plan Year:
2012
Number Of Participants:
22
Sponsors Telephone Number:

Filings

Name File Date
Dissolution 2015-07-24
Annual Report 2015-05-16
Principal Office Address Change 2014-10-20
Annual Report Amendment 2014-10-20
Registered Agent name/address change 2014-10-20

USAspending Awards / Contracts

Procurement Instrument Identifier:
VA24914J4067
Award Or Idv Flag:
AWARD
Award Type:
DO
Action Obligation:
-49075.61
Base And Exercised Options Value:
-49075.61
Base And All Options Value:
-49075.61
Awarding Agency Name:
Department of Veterans Affairs
Performance Start Date:
2014-09-12
Description:
IGF::CL::IGF ORTHO SPINE SERVICES - FUNDING ONLY ACTION - DE-OBLIGATION OF FISCAL YEAR 2014 FUNDING
Naics Code:
621498: ALL OTHER OUTPATIENT CARE CENTERS
Product Or Service Code:
Q523: MEDICAL- SURGERY
Procurement Instrument Identifier:
VA24913F2919
Award Or Idv Flag:
AWARD
Award Type:
DO
Action Obligation:
124800.00
Base And Exercised Options Value:
124800.00
Base And All Options Value:
124800.00
Awarding Agency Name:
Department of Veterans Affairs
Performance Start Date:
2013-06-01
Description:
ORTHO SPINE SERVICES IGF::CT::IGF
Naics Code:
621498: ALL OTHER OUTPATIENT CARE CENTERS
Product Or Service Code:
Q523: MEDICAL- SURGERY
Procurement Instrument Identifier:
VA24912J0392
Award Or Idv Flag:
AWARD
Award Type:
DO
Action Obligation:
37000.00
Base And Exercised Options Value:
37000.00
Base And All Options Value:
37000.00
Awarding Agency Name:
Department of Veterans Affairs
Performance Start Date:
2012-09-24
Description:
ORTHO SPINE SERVICES
Naics Code:
621498: ALL OTHER OUTPATIENT CARE CENTERS
Product Or Service Code:
Q523: MEDICAL- SURGERY

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Sources: Kentucky Secretary of State