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Mississippi Medical Clinic, LLC

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Company Details

Name: Mississippi Medical Clinic, LLC
Jurisdiction: MISSISSIPPI
Business Type: Limited Liability Company
Status: Good Standing
Effective Date: 12 Jul 2021 (4 years ago)
Business ID: 1293485
ZIP code: 39168
County: Smith
State of Incorporation: MISSISSIPPI
Principal Office Address: 403 PINE STTAYLORSVILLE, MS 39168

Agent

Name Role Address
Daniel Ferguson Agent 1284 Main Street South, Mendenhall, MS 39114

Member

Name Role Address
Daniel Ferguson Member 1284 Main Street South, Mendenhall, MS 39114
Brent A Bullock Member 11 Hidden Hollow Drive, Laurel, MS 39443
Patricia Bullock Member 11 Hidden Hollow Drive, Laurel, MS 39443
Chante N Ferguson Member 1284 Main Street South, Mendenhall, MS 39114

U.S. Small Business Administration Profile

Phone Number:
E-mail Address:
Contact Person:
PATRICIA BULLOCK
User ID:
P3246753

Unique Entity ID

Unique Entity ID:
FPXPRD994HG5
CAGE Code:
9UAN8
UEI Expiration Date:
2026-01-28

Business Information

Division Name:
MISSISSIPPI MEDICAL CLINIC LLC
Activation Date:
2025-01-30
Initial Registration Date:
2024-02-27

National Provider Identifier

NPI Number:
1114694536
Certification Date:
2022-04-11

Authorized Person:

Name:
MRS. PATTY BULLOCK
Role:
NP MANAGING PARTNER
Phone:

Taxonomy:

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

Contacts:

Fax:
6014527083

Filings

Type Status Filed Date Description
Annual Report LLC Filed 2025-01-26 Annual Report For Mississippi Medical Clinic, LLC
Annual Report LLC Filed 2024-03-06 Annual Report For Mississippi Medical Clinic, LLC
Annual Report LLC Filed 2023-07-21 Annual Report For Mississippi Medical Clinic, LLC
Annual Report LLC Filed 2022-04-12 Annual Report For Mississippi Medical Clinic, LLC
Amendment Form Filed 2022-02-02 Amendment For Mississippi Medical Clinic, LLC
Formation Form Filed 2021-07-12 Formation For Mississippi Medical Clinic, LLC

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Date of last update: 11 Jul 2025

Sources: Company Profile on Mississippi Secretary of State Website