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LILY CREEK MEDICAL GROUP, PSC

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Company Details

Name: LILY CREEK MEDICAL GROUP, PSC
Legal type: Kentucky Corporation
Status: Inactive
Standing: Good
Profit or Non-Profit: Profit
File Date: 19 May 1999 (26 years ago)
Organization Date: 19 May 1999 (26 years ago)
Last Annual Report: 01 Aug 2019 (6 years ago)
Organization Number: 0474394
ZIP code: 42642
City: Russell Springs, Russell Spgs, Webbs Cross Roads, Webbs X...
Primary County: Russell County
Principal Office: 92 JOE T. PETTEY DRIVE, RUSSELL SPRINGS, KY 42642
Place of Formation: KENTUCKY
Authorized Shares: 100

Registered Agent

Name Role
ROBERT L BERTRAM Registered Agent

Incorporator

Name Role
ROBERT L BERTRAM JR Incorporator

Sole Officer

Name Role
Robert L Bertram, Jr Sole Officer

National Provider Identifier

NPI Number:
1205987542

Authorized Person:

Name:
ROBERT L. BERTRAM
Role:
PRESIDENT
Phone:

Taxonomy:

Selected Taxonomy:
363LF0000X - Family Nurse Practitioner
Is Primary:
No
Selected Taxonomy:
363L00000X - Nurse Practitioner
Is Primary:
No
Selected Taxonomy:
207R00000X - Internal Medicine Physician
Is Primary:
Yes

Contacts:

Fax:
5022239829
Fax:
2708668849

Filings

Name File Date
Dissolution 2019-12-06
Annual Report 2019-08-01
Annual Report 2018-06-18
Annual Report 2017-04-24
Annual Report 2016-06-14

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Sources: Kentucky Secretary of State