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INDIANOLA CLINIC, LLC

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Company Details

Name: INDIANOLA CLINIC, LLC
Jurisdiction: MISSISSIPPI
Business Type: Limited Liability Company
Status: Good Standing
Effective Date: 27 May 1997 (28 years ago)
Business ID: 642882
ZIP code: 38756
County: Washington
State of Incorporation: MISSISSIPPI
Principal Office Address: 201 BAKER BOULEVARDLELAND, MS 38756
Fictitious names: Leland Medical Clinic
Leland Wellness Center

Manager

Name Role Address
Henry Marlin Womack Jr Manager 435 STONEVILLE RD, Leland, MS 38756
Karen C Matthews Manager 435 STONEVILLE RD, leland, MS 38756

Agent

Name Role Address
H. Marlin Womack, Jr Agent 435 Stoneville Road, stoneville , MS 38776

Unique Entity ID

Unique Entity ID:
G2K5EM78N6J3
CAGE Code:
8PAK3
UEI Expiration Date:
2025-09-17

Business Information

Doing Business As:
LELAND MEDICAL CLINIC
Division Name:
INDIANOLA CLINIC, LLC
Activation Date:
2024-09-19
Initial Registration Date:
2020-06-02

National Provider Identifier

NPI Number:
1962940908

Authorized Person:

Name:
MRS. AMY MCINTIRE
Role:
CREDENTIALING
Phone:

Taxonomy:

Selected Taxonomy:
224Z00000X - Occupational Therapy Assistant
Is Primary:
No
Selected Taxonomy:
225100000X - Physical Therapist
Is Primary:
No
Selected Taxonomy:
225200000X - Physical Therapy Assistant
Is Primary:
No
Selected Taxonomy:
225X00000X - Occupational Therapist
Is Primary:
No
Selected Taxonomy:
235Z00000X - Speech-Language Pathologist
Is Primary:
No

Contacts:

Fax:
6626864770

Filings

Type Status Filed Date Description
Annual Report LLC Filed 2025-01-27 Annual Report For INDIANOLA CLINIC, LLC
Annual Report LLC Filed 2024-04-11 Annual Report For INDIANOLA CLINIC, LLC
Annual Report LLC Filed 2024-01-30 Annual Report For INDIANOLA CLINIC, LLC
Annual Report LLC Filed 2023-01-30 Annual Report For INDIANOLA CLINIC, LLC
Annual Report LLC Filed 2022-02-10 Annual Report For INDIANOLA CLINIC, LLC
Annual Report LLC Filed 2021-01-28 Annual Report For INDIANOLA CLINIC, LLC
Fictitious Name Registration Filed 2020-09-28 Fictitious Name Registration For INDIANOLA CLINIC, LLC
Fictitious Name Registration Filed 2020-07-29 Fictitious Name Registration For INDIANOLA CLINIC, LLC
Annual Report LLC Filed 2020-05-18 Annual Report For INDIANOLA CLINIC, LLC
Annual Report LLC Filed 2019-04-03 Annual Report For INDIANOLA CLINIC, LLC

USAspending Awards / Financial Assistance

Date:
2020-06-01
Awarding Agency Name:
Federal Communications Commission
Transaction Description:
TELEHEALTH FOR LELAND MEDICAL CENTER
Obligated Amount:
448442.00
Face Value Of Loan:
0.00
Total Face Value Of Loan:
0.00

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Date of last update: 20 Jun 2025

Sources: Company Profile on Mississippi Secretary of State Website