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LEITCHFIELD PEDIATRIC CLINIC, P.S.C.

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Company Details

Name: LEITCHFIELD PEDIATRIC CLINIC, P.S.C.
Legal type: Kentucky Professional Services Corp
Status: Active
Standing: Good
Profit or Non-Profit: Profit
File Date: 22 Jul 1996 (29 years ago)
Organization Date: 22 Jul 1996 (29 years ago)
Last Annual Report: 28 Jan 2025 (6 months ago)
Organization Number: 0419126
Industry: Health Services
Number of Employees: Medium (20-99)
ZIP code: 42754
City: Leitchfield
Primary County: Grayson County
Principal Office: 901 WALLACE AVE, LEITCHFIELD, KY 42754
Place of Formation: KENTUCKY
Authorized Shares: 100

Registered Agent

Name Role
ANTHONY SMITH Registered Agent

Incorporator

Name Role
JOSEPH M. LEE, M.D. Incorporator

President

Name Role
John E Evans President

Vice President

Name Role
Anthony K Smtih Vice President

Director

Name Role
John E Evans Director
Anthony K Smith Director
Elizabeth S Stivers Director

Shareholder

Name Role
John E Evans Shareholder
Anthony K Smith Shareholder
Elizabeth S Stivers Shareholder

U.S. Small Business Administration Profile

Phone Number:
Fax Number:
270-259-5309
Contact Person:
LYNN ROBINSON
Ownership and Self-Certifications:
Self-Certified Small Disadvantaged Business
User ID:
P2556430
Trade Name:
LEITCHFIELD PEDITRICS

Unique Entity ID

Unique Entity ID:
XA9MHRCUD663
CAGE Code:
8SH28
UEI Expiration Date:
2025-09-27

Business Information

Doing Business As:
LEITCHFIELD PEDITRICS
Division Name:
LEITCHFIELD PEDIATRIC CLINIC PSC
Activation Date:
2024-10-01
Initial Registration Date:
2020-11-02

National Provider Identifier

NPI Number:
1558318543
Certification Date:
2020-10-20

Authorized Person:

Name:
LYNN ROBINSON
Role:
CREDITIALING
Phone:

Taxonomy:

Selected Taxonomy:
208000000X - Pediatrics Physician
Is Primary:
No
Selected Taxonomy:
363LP0200X - Pediatric Nurse Practitioner
Is Primary:
No
Selected Taxonomy:
261QR1300X - Rural Health Clinic/Center
Is Primary:
Yes

Contacts:

Fax:
2702595309

Form 5500 Series

Employer Identification Number (EIN):
611306896
Plan Year:
2024
Number Of Participants:
30
Sponsors Telephone Number:
Plan Year:
2020
Number Of Participants:
29
Sponsors Telephone Number:
Plan Year:
2019
Number Of Participants:
27
Sponsors Telephone Number:
Plan Year:
2018
Number Of Participants:
25
Sponsors Telephone Number:
Plan Year:
2017
Number Of Participants:
26
Sponsors Telephone Number:

Filings

Name File Date
Annual Report 2025-01-28
Annual Report 2024-03-25
Annual Report 2023-03-20
Annual Report 2022-03-10
Annual Report 2021-04-13

Paycheck Protection Program

Jobs Reported:
35
Initial Approval Amount:
$445,800
Date Approved:
2020-04-04
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$328,400
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Unanswered
Veteran:
Unanswered
Forgiveness Amount:
$330,251.81
Servicing Lender:
The Cecilian Bank
Use of Proceeds:
Payroll: $328,400

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Sources: Kentucky Secretary of State