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Dixie Primary Care LLC

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Company Details

Name: Dixie Primary Care LLC
Legal type: Kentucky Limited Liability Company
Status: Inactive
Standing: Bad
Profit or Non-Profit: Profit
File Date: 30 Sep 2009 (16 years ago)
Organization Date: 30 Sep 2009 (16 years ago)
Last Annual Report: 29 Jul 2010 (15 years ago)
Managed By: Members
Organization Number: 0744839
ZIP code: 40258
City: Louisville, Pleasure Rdge, Pleasure Ridge Park
Primary County: Jefferson County
Principal Office: 8033 Dixie Highway, Louisville, KY 40258
Place of Formation: KENTUCKY

Member

Name Role
VICTOR J SHPILBERG Member

Organizer

Name Role
Sean E Mumaw Organizer

Registered Agent

Name Role
Robert V. Waterman Registered Agent

National Provider Identifier

NPI Number:
1053645572

Authorized Person:

Name:
DR. VICTOR SHPILBERG
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
363L00000X - Nurse Practitioner
Is Primary:
No
Selected Taxonomy:
363A00000X - Physician Assistant
Is Primary:
No
Selected Taxonomy:
207Q00000X - Family Medicine Physician
Is Primary:
Yes

Contacts:

Fax:
5029350743

Filings

Name File Date
Administrative Dissolution 2011-09-10
Annual Report 2010-07-29

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Sources: Kentucky Secretary of State