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BELLEFONTE PHYSICIAN SERVICES, INC.

Company Details

Name: BELLEFONTE PHYSICIAN SERVICES, INC.
Legal type: Name Reservation
Status: Inactive
Standing: Good
Profit or Non-Profit: Non-profit
File Date: 22 Jan 2008 (17 years ago)
Organization Date: 29 Jan 2008 (17 years ago)
Authority Date: 22 Jan 2008 (17 years ago)
Last Annual Report: 01 Apr 2019 (6 years ago)
Managed By: Managers
Organization Number: 0683527
Principal Office: 1000 ST CHRISTOPHER DR, ASHLAND, KY 41101
Place of Formation: KENTUCKY

Chairman

Name Role
Kevin Halter Chairman

President

Name Role
Thom Morris President

Secretary

Name Role
Troy Connett Secretary

Treasurer

Name Role
Tyler Walters Treasurer

Director

Name Role
John Darnell Director
James Payne Director
Kevin Halter Director
Samuel Ross Director
Thom Morris Director
Melinda Elkins-Smith Director
MARK GORDON Director
CRAIGAN GRAY Director
ROSE MARIE JASINSKI Director

Incorporator

Name Role
ANGELA FOLTZ Incorporator

Organizer

Name Role
MICHAEL MCQUEARY Organizer

National Provider Identifier

NPI Number:
1811484264

Authorized Person:

Name:
TROY CONNETT
Role:
DIRECTOR OF FINANCE
Phone:

Taxonomy:

Selected Taxonomy:
207P00000X - Emergency Medicine Physician
Is Primary:
No
Selected Taxonomy:
207Q00000X - Family Medicine Physician
Is Primary:
No
Selected Taxonomy:
363AM0700X - Medical Physician Assistant
Is Primary:
No
Selected Taxonomy:
363LF0000X - Family Nurse Practitioner
Is Primary:
No
Selected Taxonomy:
207R00000X - Internal Medicine Physician
Is Primary:
Yes

Contacts:

Fax:
6068334668

Assumed Names

Name Status Expiration Date
BELLEFONTE PEDIATRICS RUSSELL Inactive 2024-06-01
BELLEFONTE PRIMARY CARE-GREENUP Inactive 2023-09-16
BELLEFONTE URGENT CARE-WHEELERSBURG Inactive 2023-09-16
BELLEFONTE PULMONARY ASSOCIATES Inactive 2023-09-13
TRI-STATE NEURO SOLUTIONS Inactive 2023-09-13

Filings

Name File Date
Administrative Dissolution Return 2020-12-18
Administrative Dissolution 2020-10-08
Sixty Day Notice Return 2020-08-24
Articles of Organization (LLC) 2019-12-19
Annual Report 2019-04-01

Sources: Kentucky Secretary of State