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MAIN STREET MEDICAL CLINIC LLC

Company Details

Name: MAIN STREET MEDICAL CLINIC LLC
Legal type: Kentucky Limited Liability Company
Status: Inactive
Standing: Bad
Profit or Non-Profit: Profit
File Date: 17 Aug 2023 (2 years ago)
Organization Date: 17 Aug 2023 (2 years ago)
Managed By: Members
Organization Number: 1301903
ZIP code: 41143
City: Grayson, Fultz, Johns Run
Primary County: Carter County
Principal Office: 107 E Main St, Grayson, KY 41143
Place of Formation: KENTUCKY

Organizer

Name Role
Michelle Boggs Organizer

Registered Agent

Name Role
MICHELLE L BOGGS Registered Agent

National Provider Identifier

NPI Number:
1952180408
Certification Date:
2023-09-25

Authorized Person:

Name:
STACY HOLLEY
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
363LF0000X - Family Nurse Practitioner
Is Primary:
Yes

Contacts:

Fax:
6064740412

Filings

Name File Date
Administrative Dissolution 2024-10-12

Sources: Kentucky Secretary of State