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Excellence Concierge Medicine LLC

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Company Details

Name: Excellence Concierge Medicine LLC
Jurisdiction: MISSISSIPPI
Business Type: Limited Liability Company
Status: Good Standing
Effective Date: 27 Apr 2023 (2 years ago)
Business ID: 1390402
ZIP code: 38654
County: DeSoto
State of Incorporation: MISSISSIPPI
Principal Office Address: 7712 Keri CvOlive Branch, MS 38654

Agent

Name Role Address
Gregory A White Sr Agent 7712 Keri Cv, Olive Branch, MS 38654

Manager

Name Role Address
Gregory A White Sr Manager 7712 Keri Cv, Olive Branch, MS 38654

President

Name Role Address
Miranda White President 7712 KERI CV, OLIVE BRANCH, MS 38654

U.S. Small Business Administration Profile

Phone Number:
E-mail Address:
Contact Person:
MIRANDA WHITE
Ownership and Self-Certifications:
Black American, Other Minority Owned, Self-Certified Small Disadvantaged Business, Women-Owned Small Business, Woman Owned
User ID:
P3243665

Unique Entity ID

Unique Entity ID:
FK9GXN8HUAS1
CAGE Code:
9TYN3
UEI Expiration Date:
2026-02-25

Business Information

Activation Date:
2025-02-27
Initial Registration Date:
2024-02-28

National Provider Identifier

NPI Number:
1124718366
Certification Date:
2023-05-08

Authorized Person:

Name:
MRS. MIRANDA D WHITE
Role:
FNP/CEO
Phone:

Taxonomy:

Selected Taxonomy:
363LC1500X - Community Health Nurse Practitioner
Is Primary:
Yes

Contacts:

Filings

Type Status Filed Date Description
Amendment Form Filed 2024-02-26 Amendment For Excellence Concierge Medicine LLC
Annual Report LLC Filed 2024-02-06 Annual Report For Excellence Concierge Medicine LLC
Formation Form Filed 2023-04-26 Formation For Excellence Concierge Medicine LLC

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Date of last update: 20 Jul 2025

Sources: Company Profile on Mississippi Secretary of State Website