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MOUNTAIN FAMILY MEDICINE, LLC

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Company Details

Name: MOUNTAIN FAMILY MEDICINE, LLC
Legal type: Kentucky Limited Liability Company
Status: Inactive
Standing: Bad
Profit or Non-Profit: Profit
File Date: 05 Mar 2014 (11 years ago)
Organization Date: 05 Mar 2014 (11 years ago)
Last Annual Report: 16 Aug 2023 (2 years ago)
Managed By: Members
Organization Number: 0881046
ZIP code: 41501
City: Pikeville, Broad Bottom, Gulnare, Mccombs, Meta, Ne...
Primary County: Pike County
Principal Office: 5425 NORTH MAYO TRAIL, STE 201, PIKEVILLE, KY 41501
Place of Formation: KENTUCKY

Registered Agent

Name Role
BRIAN P. DANIELS, DO Registered Agent

Member

Name Role
Brian P Daniels Member

Organizer

Name Role
RAYMOND O. BISHOP, M.D. Organizer

National Provider Identifier

NPI Number:
1073079273
Certification Date:
2021-10-11

Authorized Person:

Name:
DR. BRIAN DANIELS
Role:
OWNER/PHYSICIAN
Phone:

Taxonomy:

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

Contacts:

Form 5500 Series

Employer Identification Number (EIN):
465655603
Plan Year:
2017
Number Of Participants:
5
Sponsors Telephone Number:
Plan Year:
2016
Number Of Participants:
6
Sponsors Telephone Number:
Plan Year:
2015
Number Of Participants:
4
Sponsors Telephone Number:

Filings

Name File Date
Administrative Dissolution 2024-10-12
Annual Report 2023-08-16
Reinstatement 2022-10-24
Reinstatement Approval Letter Revenue 2022-10-24
Reinstatement Certificate of Existence 2022-10-24

USAspending Awards / Financial Assistance

Date:
2020-04-07
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO AID SMALL BUSINESSES IN MAINTAINING WORK FORCE DURING COVID-19 PANDEMIC.
Obligated Amount:
0.00
Face Value Of Loan:
74000.00
Total Face Value Of Loan:
74000.00
Date:
2018-06-01
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO AID SMALL BUSINESSES WHICH ARE UNABLE TO OBTAIN FINANCING IN THE PRIVATE CREDIT MARKETPLACE
Obligated Amount:
0.00
Face Value Of Loan:
25000.00
Total Face Value Of Loan:
25000.00
Date:
2016-05-20
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO AID SMALL BUSINESSES WHICH ARE UNABLE TO OBTAIN FINANCING IN THE PRIVATE CREDIT MARKETPLACE
Obligated Amount:
0.00
Face Value Of Loan:
60000.00
Total Face Value Of Loan:
60000.00
Date:
2014-07-18
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO AID SMALL BUSINESSES WHICH ARE UNABLE TO OBTAIN FINANCING IN THE PRIVATE CREDIT MARKETPLACE
Obligated Amount:
0.00
Face Value Of Loan:
50000.00
Total Face Value Of Loan:
0.00

Paycheck Protection Program

Date Approved:
2020-04-07
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Initial Approval Amount:
74000
Current Approval Amount:
74000
Race:
White
Ethnicity:
Not Hispanic or Latino
Gender:
Male Owned
Veteran:
Non-Veteran
Forgiveness Amount:
74687.29

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Sources: Kentucky Secretary of State