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MERCY CLINIC OF JACKSON, PLLC

Company Details

Name: MERCY CLINIC OF JACKSON, PLLC
Legal type: Kentucky Limited Liability Company
Status: Active
Standing: Good
Profit or Non-Profit: Profit
File Date: 23 Feb 2005 (20 years ago)
Organization Date: 23 Feb 2005 (20 years ago)
Last Annual Report: 12 Feb 2025 (4 months ago)
Managed By: Managers
Organization Number: 0606791
Industry: Health Services
Number of Employees: Small (0-19)
ZIP code: 41339
City: Jackson, Altro, Athol, Canoe, Decoy, Elkatawa, Fr...
Primary County: Breathitt County
Principal Office: 1550 KY. HWY. 15 SOUTH, STE 80, JACKSON, KY 41339
Place of Formation: KENTUCKY

Member

Name Role
CESAR O AGTARAP, MD Member

Manager

Name Role
AIDA A RYNKOWSKI Manager

Registered Agent

Name Role
CESAR O. AGTARAP, M.D. Registered Agent

Organizer

Name Role
CESAR O. AGTARAT, M.D. Organizer

National Provider Identifier

NPI Number:
1306047105

Authorized Person:

Name:
SUSAN PRATT
Role:
CLINIC MANAGER
Phone:

Taxonomy:

Selected Taxonomy:
174400000X - Specialist
Is Primary:
Yes

Contacts:

Fax:
6066930322

Form 5500 Series

Employer Identification Number (EIN):
202416550
Plan Year:
2014
Number Of Participants:
5
Sponsors Telephone Number:
Plan Year:
2013
Number Of Participants:
8
Sponsors Telephone Number:
Plan Year:
2012
Number Of Participants:
15
Sponsors Telephone Number:
Plan Year:
2011
Number Of Participants:
15
Sponsors Telephone Number:
Plan Year:
2010
Number Of Participants:
18
Sponsors Telephone Number:

Filings

Name File Date
Annual Report Amendment 2025-02-12
Annual Report 2025-02-12
Annual Report 2024-03-06
Principal Office Address Change 2024-03-06
Annual Report 2023-03-16

Sources: Kentucky Secretary of State