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BROOKHAVEN SURGERY CLINIC, P.A.

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Company Details

Name: BROOKHAVEN SURGERY CLINIC, P.A.
Jurisdiction: MISSISSIPPI
Business Type: Profit Corporation
Status: Good Standing
Effective Date: 21 Jan 1993 (32 years ago)
Business ID: 594290
ZIP code: 39601
County: Lincoln
State of Incorporation: MISSISSIPPI
Principal Office Address: 1036 Biglane DriveBrookhaven, MS 39601

Agent

Name Role Address
Charles Asa Reynolds MD Agent 1036 Biglane Drive, Brookhaven, MS 39601

Incorporator

Name Role Address
D Michael Cockrell Incorporator 600 Heritage Bldg, Congress At Capitol, Jackson, MS 39201

Director

Name Role Address
Charles Asa Reynolds Director 1036 Biglane Drive, Brookhaven, MS 39601

President

Name Role Address
Charles Asa Reynolds President 1036 Biglane Drive, Brookhaven, MS 39601

Secretary

Name Role Address
Charles Asa Reynolds Secretary 1036 Biglane Drive, Brookhaven, MS 39601

Treasurer

Name Role Address
Charles Asa Reynolds Treasurer 1036 Biglane Drive, Brookhaven, MS 39601

National Provider Identifier

NPI Number:
1760578736

Authorized Person:

Name:
DAVID VANCE CARNER
Role:
PRESIDENT
Phone:

Taxonomy:

Selected Taxonomy:
208600000X - Surgery Physician
Is Primary:
Yes

Contacts:

Fax:
6018351546

Form 5500 Series

Employer Identification Number (EIN):
640822726
Plan Year:
2023
Number Of Participants:
10
Sponsors Telephone Number:
Plan Year:
2022
Number Of Participants:
11
Sponsors Telephone Number:
Plan Year:
2021
Number Of Participants:
11
Sponsors Telephone Number:
Plan Year:
2020
Number Of Participants:
11
Sponsors Telephone Number:
Plan Year:
2019
Number Of Participants:
11
Sponsors Telephone Number:

Filings

Type Status Filed Date Description
Annual Report Filed 2025-01-13 Annual Report For BROOKHAVEN SURGERY CLINIC, P.A.
Annual Report Filed 2024-02-21 Annual Report For BROOKHAVEN SURGERY CLINIC, P.A.
Annual Report Filed 2023-02-21 Annual Report For BROOKHAVEN SURGERY CLINIC, P.A.
Amendment Form Filed 2022-10-13 Amendment For BROOKHAVEN SURGERY CLINIC, P.A.
Annual Report Filed 2022-02-02 Annual Report For BROOKHAVEN SURGERY CLINIC, P.A.
Annual Report Filed 2021-02-01 Annual Report For BROOKHAVEN SURGERY CLINIC, P.A.
Annual Report Filed 2020-02-05 Annual Report For BROOKHAVEN SURGERY CLINIC, P.A.
Annual Report Filed 2019-02-26 Annual Report For BROOKHAVEN SURGERY CLINIC, P.A.
Annual Report Filed 2018-04-04 Annual Report For BROOKHAVEN SURGERY CLINIC, P.A.
Amendment Form Filed 2018-01-18 Amendment For BROOKHAVEN SURGERY CLINIC, P.A.

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Date of last update: 22 Apr 2025

Sources: Mississippi Secretary of State