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WILLIAMSBURG FAMILY PRACTICE CLINIC, INC.

Company Details

Name: WILLIAMSBURG FAMILY PRACTICE CLINIC, INC.
Legal type: Kentucky Corporation
Status: Inactive
Standing: Bad
Profit or Non-Profit: Profit
File Date: 01 Jul 1999 (26 years ago)
Organization Date: 01 Jul 1999 (26 years ago)
Last Annual Report: 28 Aug 2007 (18 years ago)
Organization Number: 0476544
ZIP code: 40702
City: Corbin
Primary County: Whitley County
Principal Office: P.O. Box 1125, CORBIN, KY 40702
Place of Formation: KENTUCKY
Authorized Shares: 1000

Director

Name Role
Robert A Carter Director

Incorporator

Name Role
ROBERT A. CARTER, JR. Incorporator

Sole Officer

Name Role
Robert A Carter Sole Officer

Registered Agent

Name Role
206 SOUTH MAIN STREET Registered Agent

National Provider Identifier

NPI Number:
1720030620

Authorized Person:

Name:
ROBERT A. CARTER
Role:
PRESIDENT
Phone:

Taxonomy:

Selected Taxonomy:
207Q00000X - Family Medicine Physician
Is Primary:
Yes

Contacts:

Fax:
6065288422
Fax:
6065491945

Form 5500 Series

Employer Identification Number (EIN):
611350105
Plan Year:
2010
Number Of Participants:
0
Sponsors Telephone Number:
Plan Year:
2009
Number Of Participants:
0
Sponsors Telephone Number:

Assumed Names

Name Status Expiration Date
WILLIAMSBURG FAMILY PRACTICE CLINIC Inactive 2010-10-05
CORBIN FAMILY PRACTICE CLINIC Inactive 2004-11-24

Filings

Name File Date
Administrative Dissolution 2008-03-20
Sixty Day Notice 2007-12-13
Agent Resignation 2007-09-04
Annual Report Amendment 2007-08-28
Statement of Change 2007-08-23

Sources: Kentucky Secretary of State