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ELITE PHYSICAL MEDICINE LLC

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Company Details

Name: ELITE PHYSICAL MEDICINE LLC
Legal type: Kentucky Limited Liability Company
Status: Inactive
Standing: Bad
Profit or Non-Profit: Profit
File Date: 14 Feb 2019 (6 years ago)
Organization Date: 14 Feb 2019 (6 years ago)
Last Annual Report: 17 Oct 2023 (2 years ago)
Managed By: Members
Organization Number: 1048499
ZIP code: 41048
City: Hebron
Primary County: Boone County
Principal Office: 2091 NORTH BEND ROAD, HEBRON, KY 41048
Place of Formation: KENTUCKY

Member

Name Role
Craig George Member
Benjamin Kasle Member
David Segraves Member
Scott Shelby Member
Michael Teifke Member

Registered Agent

Name Role
C T CORPORATION SYSTEM Registered Agent

Organizer

Name Role
DAVID SEGRAVES Organizer

National Provider Identifier

NPI Number:
1730709601
Certification Date:
2023-04-04

Authorized Person:

Name:
DAVID SEGRAVES
Role:
CEO
Phone:

Taxonomy:

Selected Taxonomy:
111N00000X - Chiropractor
Is Primary:
No
Selected Taxonomy:
208100000X - Physical Medicine & Rehabilitation Physician
Is Primary:
No
Selected Taxonomy:
363L00000X - Nurse Practitioner
Is Primary:
No
Selected Taxonomy:
208VP0014X - Interventional Pain Medicine Physician
Is Primary:
Yes

Contacts:

Assumed Names

Name Status Expiration Date
ELITE PAIN DOCTORS Active 2028-10-20

Filings

Name File Date
Administrative Dissolution 2024-10-12
Certificate of Assumed Name 2023-10-20
Reinstatement 2023-10-17
Reinstatement Approval Letter Revenue 2023-10-17
Reinstatement Certificate of Existence 2023-10-17

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Sources: Kentucky Secretary of State