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Greenbrook Physician Services, LLC

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Company Details

Name: Greenbrook Physician Services, LLC
Jurisdiction: MISSISSIPPI
Business Type: Limited Liability Company
Status: Good Standing
Effective Date: 10 Apr 2025 (2 months ago)
Business ID: 1484977
State of Incorporation: MISSISSIPPI

Agent

Name Role Address
C T CORPORATION SYSTEM Agent 645 LAKELAND EAST DRIVE STE 101, FLOWOOD, MS 39232

Organizer

Name Role Address
LISHA FALK Organizer 200 CORPORATE BLVD, LAFAYETTE, LA 70508

National Provider Identifier

NPI Number:
1801683008
Certification Date:
2025-04-22

Authorized Person:

Name:
LISHA C FALK
Role:
VICE PRESIDENT
Phone:

Taxonomy:

Selected Taxonomy:
208M00000X - Hospitalist Physician
Is Primary:
No
Selected Taxonomy:
363A00000X - Physician Assistant
Is Primary:
No
Selected Taxonomy:
363L00000X - Nurse Practitioner
Is Primary:
No
Selected Taxonomy:
207R00000X - Internal Medicine Physician
Is Primary:
Yes

Contacts:

Fax:
6623494038

Filings

Type Status Filed Date Description
Formation Form Filed 2025-04-10 Formation For Greenbrook Physician Services, LLC

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Date of last update: 01 May 2025

Sources: Company Profile on Mississippi Secretary of State Website