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BOURBON PHYSICIAN PRACTICE, LLC

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Company Details

Name: BOURBON PHYSICIAN PRACTICE, LLC
Legal type: Foreign Limited Liability Company
Status: Active
Standing: Good
File Date: 07 Jul 2000 (25 years ago)
Authority Date: 07 Jul 2000 (25 years ago)
Last Annual Report: 28 Jun 2024 (a year ago)
Organization Number: 0497417
Industry: Health Services
Number of Employees: Small (0-19)
Principal Office: 330 SEVEN SPRINGS WAY, BRENTWOOD, TN 37027
Place of Formation: DELAWARE

Organizer

Name Role
WILLIAM F. CARPENTER, III Organizer

Manager

Name Role
Lifepoint of Kentucky, LLC Manager

Registered Agent

Name Role
C T CORPORATION SYSTEM Registered Agent

National Provider Identifier

NPI Number:
1962111716
Certification Date:
2024-04-01

Authorized Person:

Name:
MONICA BOWMAN
Role:
PRESIDENT
Phone:

Taxonomy:

Selected Taxonomy:
261QR1300X - Rural Health Clinic/Center
Is Primary:
Yes

Contacts:

Assumed Names

Name Status Expiration Date
BOURBON MEDICAL GROUP Active 2029-12-22
CENTRAL KENTUCKY PAIN AND SPINE- PARIS Active 2029-06-20
CENTRAL KENTUCKY HEART CARE- BOURBON Active 2028-12-19
BOURBON THERAPEUTIC INTERVENTIONS Active 2026-12-29
BOURBON NEUROLOGY Inactive 2026-02-03

Filings

Name File Date
Name Renewal 2024-12-04
Certificate of Assumed Name 2024-11-04
Certificate of Assumed Name 2024-11-04
Certificate of Withdrawal of Assumed Name 2024-06-28
Annual Report 2024-06-28

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Sources: Kentucky Secretary of State