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CAMPBELL MEDICAL GROUP MD, P.S.C.

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Company Details

Name: CAMPBELL MEDICAL GROUP MD, P.S.C.
Legal type: Kentucky Professional Services Corp
Status: Inactive
Standing: Good
Profit or Non-Profit: Profit
File Date: 21 May 2004 (21 years ago)
Organization Date: 21 May 2004 (21 years ago)
Last Annual Report: 11 Sep 2013 (12 years ago)
Organization Number: 0586569
ZIP code: 42141
City: Glasgow, Lamb
Primary County: Barren County
Principal Office: 303 PROFESSIONAL PARK DRIVE, GLASGOW, KY 42141
Place of Formation: KENTUCKY
Authorized Shares: 1000

Registered Agent

Name Role
JASON CAMPBELL, M.D. Registered Agent

President

Name Role
Jason Campbell President

Vice President

Name Role
Alison Campbell Vice President

Director

Name Role
Jason Campbell Director
Alison Campbell Director

Shareholder

Name Role
Jason Campbell Shareholder
Alison Campbell Shareholder

Incorporator

Name Role
JASON CAMPBELL, M.D. Incorporator
ALISON CAMPBELL, M.D. Incorporator

National Provider Identifier

NPI Number:
1003000803

Authorized Person:

Name:
MS. JENNIFER DALTON GIBSON
Role:
OFFICE MANAGER
Phone:

Taxonomy:

Selected Taxonomy:
207RA0000X - Adolescent Medicine (Internal Medicine) Physician
Is Primary:
No
Selected Taxonomy:
363L00000X - Nurse Practitioner
Is Primary:
No
Selected Taxonomy:
207Q00000X - Family Medicine Physician
Is Primary:
Yes

Contacts:

Fax:
2706293774

Filings

Name File Date
Dissolution 2014-03-14
Annual Report 2013-09-11
Annual Report 2012-05-01
Annual Report 2011-03-25
Annual Report 2010-04-15

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Sources: Kentucky Secretary of State