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Mississippi Belmont Clinic, LLC

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Company Details

Name: Mississippi Belmont Clinic, LLC
Jurisdiction: MISSISSIPPI
Business Type: Limited Liability Company
Status: Revoked
Effective Date: 20 Sep 2017 (8 years ago)
Business ID: 1128333
State of Incorporation: TENNESSEE
Principal Office Address: 1721 Midpark Road, Suite B200Knoxville, TN 37921
Historical names: Belmont Medical Clinic

Agent

Name Role Address
CORPORATION SERVICE COMPANY Agent 109 Executive Drive, Suite 3, Madison, MS 39110

Secretary

Name Role Address
Sarah Moore Secretary 1721 Midpark Road, Suite B200, Knoxville, TN 37921

National Provider Identifier

NPI Number:
1134631641

Authorized Person:

Name:
DR. DONALD R RATLIFF
Role:
PROVIDER
Phone:

Taxonomy:

Selected Taxonomy:
207Q00000X - Family Medicine Physician
Is Primary:
Yes

Contacts:

Filings

Type Status Filed Date Description
Registered Agent Change of Address Filed 2022-03-31 Agent Address Change For CORPORATION SERVICE COMPANY
Admin Dissolution Filed 2018-12-10 Admin Dissolution: AR
Notice to Dissolve/Revoke Filed 2018-09-07 Notice to Dissolve/Revoke
Fictitious Name Registration Filed 2017-09-20 Fictitious Name Registration For Mississippi Belmont Clinic, LLC
Formation Form Filed 2017-09-20 Formation For Mississippi Belmont Clinic, LLC

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Date of last update: 18 May 2025

Sources: Company Profile on Mississippi Secretary of State Website