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BLUEGRASS PAIN MANAGEMENT, P.S.C.

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Company Details

Name: BLUEGRASS PAIN MANAGEMENT, P.S.C.
Legal type: Kentucky Professional Services Corp
Status: Inactive
Standing: Bad
Profit or Non-Profit: Profit
File Date: 14 Nov 2003 (22 years ago)
Organization Date: 14 Nov 2003 (22 years ago)
Last Annual Report: 20 Jul 2016 (9 years ago)
Organization Number: 0572202
ZIP code: 40503
City: Lexington
Primary County: Fayette County
Principal Office: 1760 Nicholasville Road, Suite 503, LEXINGTON, KY 40503
Place of Formation: KENTUCKY
Authorized Shares: 1000

Registered Agent

Name Role
DAVID P. BOSOMWORTH, M.D. Registered Agent

Incorporator

Name Role
DAVID P. BOSOMWORTH, M.D. Incorporator

Sole Officer

Name Role
David P Bosomworth Sole Officer

Shareholder

Name Role
David P. Bosomworth Shareholder

National Provider Identifier

NPI Number:
1639263338

Authorized Person:

Name:
DAVID P BOSOMWORTH II
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
208VP0014X - Interventional Pain Medicine Physician
Is Primary:
Yes

Contacts:

Fax:
8599772683

Form 5500 Series

Employer Identification Number (EIN):
200409815
Plan Year:
2013
Number Of Participants:
10
Sponsors Telephone Number:

Filings

Name File Date
Administrative Dissolution Return 2017-11-16
Administrative Dissolution 2017-10-09
Sixty Day Notice Return 2017-08-29
Annual Report 2016-07-20
Annual Report 2015-08-12

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Sources: Kentucky Secretary of State