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CUMBERLAND GASTROENTEROLOGY, P.S.C.

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Company Details

Name: CUMBERLAND GASTROENTEROLOGY, P.S.C.
Legal type: Kentucky Professional Services Corp
Status: Inactive
Standing: Bad
Profit or Non-Profit: Profit
File Date: 21 Jul 1997 (28 years ago)
Organization Date: 21 Jul 1997 (28 years ago)
Last Annual Report: 04 Sep 2020 (5 years ago)
Organization Number: 0436051
ZIP code: 42503
City: Somerset
Primary County: Pulaski County
Principal Office: 56 TOWER CIRCLE, SOMERSET, KY 42503
Place of Formation: KENTUCKY
Authorized Shares: 1000

Registered Agent

Name Role
SAMIR COOK, MD Registered Agent

Shareholder

Name Role
Benjamin Bryson Shareholder
Samir Cook Shareholder
Todd Horn Shareholder

Incorporator

Name Role
OWEN MAAT MD Incorporator

President

Name Role
Samir Cook President

Secretary

Name Role
Benajmin Bryson Secretary

Vice President

Name Role
Todd Horn Vice President

Director

Name Role
Samir Cook Director
Todd Horn Director
Benjamin Bryson Director

National Provider Identifier

NPI Number:
1720160526

Authorized Person:

Name:
SAMIR ISSA COOK
Role:
PRESIDENT
Phone:

Taxonomy:

Selected Taxonomy:
363L00000X - Nurse Practitioner
Is Primary:
No
Selected Taxonomy:
207RG0100X - Gastroenterology Physician
Is Primary:
Yes

Contacts:

Fax:
6066776983

Filings

Name File Date
Administrative Dissolution 2021-10-19
Annual Report 2020-09-04
Annual Report 2019-06-26
Annual Report 2018-04-11
Annual Report 2017-04-21

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Sources: Kentucky Secretary of State