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SMB RADIOLOGY, P.A.

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Company Details

Name: SMB RADIOLOGY, P.A.
Jurisdiction: MISSISSIPPI
Business Type: Profit Corporation
Status: Good Standing
Effective Date: 29 Jun 1995 (30 years ago)
Business ID: 619768
ZIP code: 39503
County: Harrison
State of Incorporation: MISSISSIPPI
Principal Office Address: 9490 Three Rivers RoadGULFPORT, MS 39503

Agent

Name Role Address
Russell E. Allman Agent 9490 Three Rivers Road, GULFPORT, MS 39503

Incorporator

Name Role Address
David W Crane Incorporator One Hancock Plaza Ste 1209, Gulfport, MS 39501

Director

Name Role Address
Leena Pande MD Director 9490 Three Rivers Road, Gulfport, MS 39503
Russell E. Allman, M.D. Director 9490 Three Rivers Road, Gulfport, MS 39503
Eric Lawson, M.D. Director 9490 Three Rivers Road, Gulfport, MS 39503
MICHAEL J DIAZ MD Director 9490 Three Rivers Road, Gulfport, MS 39503
Jonathan B Mullins MD Director 9490 Three Rivers Road, Gulfport, MS 39503
Clifton T Leatherbury, M.D. MD Director 9490 Three Rivers Road, Gulfport, MS 39503
Daniel E Adams MD Director 9490 Three Rivers Road, Gulfport, MS 39503
Jim P Gray MD Director 9490 Three Rivers Road, Gulfport, MS 39503
John A Banahan MD Director 9490 Three Rivers Road, Gulfport, MS 39503
Roland J Mestayer MD Director 9490 Three Rivers Road, Gulfport, MS 39503

Vice President

Name Role Address
Leena Pande MD Vice President 9490 Three Rivers Road, Gulfport, MS 39503

Treasurer

Name Role Address
Russell E. Allman, M.D. Treasurer 9490 Three Rivers Road, Gulfport, MS 39503

Secretary

Name Role Address
Eric Lawson, M.D. Secretary 9490 Three Rivers Road, Gulfport, MS 39503
John A Banahan MD Secretary 9490 Three Rivers Road, Gulfport, MS 39503

National Provider Identifier

NPI Number:
1609877356
Certification Date:
2025-01-17

Authorized Person:

Name:
DR. CLIFTON T LEATHERBURY
Role:
PRESIDENT
Phone:

Taxonomy:

Selected Taxonomy:
2085R0202X - Diagnostic Radiology Physician
Is Primary:
Yes

Contacts:

Fax:
7065966704
Fax:
2287621359

Form 5500 Series

Employer Identification Number (EIN):
640863698
Plan Year:
2023
Number Of Participants:
17
Sponsors Telephone Number:
Plan Year:
2023
Number Of Participants:
18
Sponsors Telephone Number:
Plan Year:
2022
Number Of Participants:
14
Sponsors Telephone Number:
Plan Year:
2022
Number Of Participants:
9
Sponsors Telephone Number:
Plan Year:
2021
Number Of Participants:
10
Sponsors Telephone Number:

Filings

Type Status Filed Date Description
Annual Report Filed 2025-02-09 Annual Report For SMB RADIOLOGY, P.A.
Amendment Form Filed 2024-05-15 Amendment For SMB RADIOLOGY, P.A.
Annual Report Filed 2024-05-15 Annual Report For SMB RADIOLOGY, P.A.
Annual Report Filed 2023-03-15 Annual Report For SMB RADIOLOGY, P.A.
Amendment Form Filed 2022-12-30 Amendment For SMB RADIOLOGY, P.A.
Annual Report Filed 2022-03-14 Annual Report For SMB RADIOLOGY, P.A.
Annual Report Filed 2021-03-11 Annual Report For SMB RADIOLOGY, P.A.
Annual Report Filed 2020-03-23 Annual Report For SMB RADIOLOGY, P.A.
Annual Report Filed 2019-04-03 Annual Report For SMB RADIOLOGY, P.A.
Annual Report Filed 2018-03-12 Annual Report For SMB RADIOLOGY, P.A.

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Date of last update: 23 Apr 2025

Sources: Mississippi Secretary of State