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CREEKSIDE FAMILY MEDICAL CENTER, P.S.C.

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Company Details

Name: CREEKSIDE FAMILY MEDICAL CENTER, P.S.C.
Legal type: Kentucky Professional Services Corp
Status: Inactive
Standing: Bad
Profit or Non-Profit: Profit
File Date: 01 Jul 2002 (23 years ago)
Organization Date: 01 Jul 2002 (23 years ago)
Last Annual Report: 24 Jun 2016 (9 years ago)
Organization Number: 0539881
ZIP code: 40071
City: Taylorsville
Primary County: Spencer County
Principal Office: 83 WEST MAIN STREET, P.O. BOX 529, TAYLORSVILLE, KY 40071
Place of Formation: KENTUCKY
Authorized Shares: 1000

Sole Officer

Name Role
Thomas C. Crain Sole Officer

Director

Name Role
Thomas C. Crain Director

Shareholder

Name Role
Thomas C. Crain Shareholder

Signature

Name Role
THOMAS C CRAIN Signature

Registered Agent

Name Role
THOMAS C. CRAIN, M.D. Registered Agent

Incorporator

Name Role
THOMAS C. CRAIN, M.D. Incorporator

National Provider Identifier

NPI Number:
1861453524

Authorized Person:

Name:
THOMAS CECIL CRAIN
Role:
OWNER
Phone:

Taxonomy:

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

Contacts:

Fax:
5024775524

Form 5500 Series

Employer Identification Number (EIN):
810558943
Plan Year:
2015
Number Of Participants:
9
Sponsors Telephone Number:
Plan Year:
2014
Number Of Participants:
11
Sponsors Telephone Number:
Plan Year:
2013
Number Of Participants:
12
Sponsors Telephone Number:
Plan Year:
2012
Number Of Participants:
13
Sponsors Telephone Number:
Plan Year:
2011
Number Of Participants:
13
Sponsors Telephone Number:

Filings

Name File Date
Administrative Dissolution Return 2017-11-16
Administrative Dissolution 2017-10-09
Sixty Day Notice Return 2017-09-14
Annual Report 2016-06-24
Annual Report 2015-07-07

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Sources: Kentucky Secretary of State