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Rolling Fork Medical Clinic, LLC

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Company Details

Name: Rolling Fork Medical Clinic, LLC
Jurisdiction: MISSISSIPPI
Business Type: Limited Liability Company
Status: Dissolved
Effective Date: 06 Sep 2019 (6 years ago)
Business ID: 1187911
State of Incorporation: MISSISSIPPI

Agent

Name Role Address
William Grete Agent 190 E Capitol St #1400, Jackson, MS 39201

Member

Name Role Address
Conrad Ebner Member 217 Drapterton, Ridgeland, MS 39157

National Provider Identifier

NPI Number:
1275174971

Authorized Person:

Name:
LISA THOMAS HEARN
Role:
MANAGER
Phone:

Taxonomy:

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

Contacts:

Fax:
6623354105
Fax:
6623782879

Filings

Type Status Filed Date Description
Admin Dissolution Filed 2020-11-27 Action of Rolling Fork Medical Clinic, LLC: AR
Notice to Dissolve/Revoke Filed 2020-08-28 Notice to Dissolve/Revoke
Formation Form Filed 2019-09-06 Formation For Rolling Fork Medical Clinic, LLC

USAspending Awards / Financial Assistance

Date:
2020-04-08
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:
56400.00
Total Face Value Of Loan:
56400.00

Paycheck Protection Program

Date Approved:
2020-04-08
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Initial Approval Amount:
56400
Current Approval Amount:
56400
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Unanswered
Veteran:
Unanswered
Forgiveness Amount:
56979.67

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Date of last update: 21 May 2025

Sources: Company Profile on Mississippi Secretary of State Website