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MICHAEL E. BROCK, D.O., P.S.C.

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Company Details

Name: MICHAEL E. BROCK, D.O., P.S.C.
Legal type: Kentucky Professional Services Corp
Status: Inactive
Standing: Bad
Profit or Non-Profit: Profit
File Date: 20 Jan 2004 (21 years ago)
Organization Date: 20 Jan 2004 (21 years ago)
Last Annual Report: 10 May 2006 (19 years ago)
Organization Number: 0576657
ZIP code: 41101
City: Ashland, Summitt, Westwood
Primary County: Boyd County
Principal Office: 1200 BATH AVENUE, ASHLAND, KY 41101
Place of Formation: KENTUCKY
Authorized Shares: 100

Registered Agent

Name Role
MICHAEL E. BROCK DO Registered Agent

President

Name Role
MICHAEL E BROCK President

Shareholder

Name Role
MICHAEL BROCK Shareholder

Signature

Name Role
MICHEAL E BROCK Signature

Incorporator

Name Role
MICHAEL E BROCK DO Incorporator

National Provider Identifier

NPI Number:
1770782674

Authorized Person:

Name:
DR. MICHAEL EUGENE BROCK
Role:
OWNER
Phone:

Taxonomy:

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

Contacts:

Fax:
6063260650

Filings

Name File Date
Administrative Dissolution Return 2007-11-26
Administrative Dissolution 2007-11-01
Sixty Day Notice Return 2007-09-26
Annual Report 2006-05-10
Statement of Change 2005-11-04

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Sources: Kentucky Secretary of State