Search icon

BLUEGRASS DERMATOLOGY, PLLC

Company Details

Name: BLUEGRASS DERMATOLOGY, PLLC
Legal type: Kentucky Limited Liability Company
Status: Inactive
Standing: Bad
File Date: 26 Jan 2005 (20 years ago)
Organization Date: 26 Jan 2005 (20 years ago)
Last Annual Report: 27 Aug 2015 (10 years ago)
Managed By: Members
Organization Number: 0604516
ZIP code: 42001
City: Paducah
Primary County: McCracken County
Principal Office: 4616 VILLAGE SQUARE DRIVE, PADUCAH, KY 42001
Place of Formation: KENTUCKY

Organizer

Name Role
DOUGLAS WILSON, M.D. Organizer

Registered Agent

Name Role
DOUGLAS M. WILSON Registered Agent

Manager

Name Role
Melissa Wilson Manager

National Provider Identifier

NPI Number:
1881740884

Authorized Person:

Name:
DOUGLAS M WILSON
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
207N00000X - Dermatology Physician
Is Primary:
Yes

Contacts:

Fax:
2704434002

Form 5500 Series

Employer Identification Number (EIN):
320138797
Plan Year:
2014
Number Of Participants:
12
Sponsors Telephone Number:
Plan Year:
2013
Number Of Participants:
12
Sponsors Telephone Number:
Plan Year:
2012
Number Of Participants:
10
Sponsors Telephone Number:
Plan Year:
2012
Number Of Participants:
10
Sponsors Telephone Number:
Plan Year:
2011
Number Of Participants:
10
Sponsors Telephone Number:

Filings

Name File Date
Administrative Dissolution 2016-10-01
Annual Report 2015-08-27
Annual Report 2014-07-17
Annual Report 2013-02-05
Annual Report 2012-02-13

Sources: Kentucky Secretary of State