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OWENSBORO FAMILY MEDICINE, P.S.C.

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Company Details

Name: OWENSBORO FAMILY MEDICINE, P.S.C.
Legal type: Kentucky Professional Services Corp
Status: Inactive
Standing: Bad
Profit or Non-Profit: Profit
File Date: 01 Mar 1993 (33 years ago)
Organization Date: 01 Mar 1993 (33 years ago)
Last Annual Report: 27 Mar 2015 (10 years ago)
Organization Number: 0311989
ZIP code: 42302
City: Owensboro
Primary County: Daviess County
Principal Office: 1325 TRIPLETT STREET, P.O. BOX 1370, OWENSBORO, KY 42302
Place of Formation: KENTUCKY
Authorized Shares: 1000

Registered Agent

Name Role
JESSE T. MOUNTJOY, ESQ. Registered Agent

Vice President

Name Role
Benjamin D. Keeley Vice President

Shareholder

Name Role
Benjamin D Keeley Shareholder
GARY J. WAHL Shareholder

Director

Name Role
BILL J. BRYANT, M.D. Director
JAMES F. LITSEY, M.D. Director
GARY J. WAHL, M.D. Director

Incorporator

Name Role
BILL J. BRYANT, M.D. Incorporator

President

Name Role
Gary J Wahl President

National Provider Identifier

NPI Number:
1881879542

Authorized Person:

Name:
MS. SANDY GOODMAN
Role:
OFFICE MANAGER
Phone:

Taxonomy:

Selected Taxonomy:
363L00000X - Nurse Practitioner
Is Primary:
Yes

Contacts:

Form 5500 Series

Employer Identification Number (EIN):
611240729
Plan Year:
2016
Number Of Participants:
19
Sponsors Telephone Number:
Plan Year:
2015
Number Of Participants:
27
Sponsors Telephone Number:
Plan Year:
2014
Number Of Participants:
28
Sponsors Telephone Number:
Plan Year:
2013
Number Of Participants:
26
Sponsors Telephone Number:
Plan Year:
2012
Number Of Participants:
27
Sponsors Telephone Number:

Filings

Name File Date
Administrative Dissolution 2016-10-01
Annual Report 2015-03-27
Annual Report 2014-03-14
Annual Report 2013-02-12
Annual Report 2012-01-31

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Sources: Kentucky Secretary of State