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GOOD SAMARITAN PHYSICAL THERAPY, INC.

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Company Details

Name: GOOD SAMARITAN PHYSICAL THERAPY, INC.
Jurisdiction: MISSISSIPPI
Business Type: Profit Corporation
Status: Dissolved
Effective Date: 16 Jun 1997 (28 years ago)
Business ID: 643685
ZIP code: 39180
County: Warren
State of Incorporation: MISSISSIPPI
Principal Office Address: 1901 A MISSION 66VICKSBURG, MS 39180

Agent

Name Role Address
TAMMY DAVENPORT Agent 1901 A MISSION 66, P O BOX 822394, VICKSBURG, MS 39182-2394

Incorporator

Name Role Address
Tammy Davenport Incorporator 4313 Knights Ln, Vicksburg, MS 39180

Director

Name Role Address
Tammy E Davenport Director 1901a Mission 66, Vicksburg, MS 39180

President

Name Role Address
Tammy E Davenport President 1901a Mission 66, Vicksburg, MS 39180

National Provider Identifier

NPI Number:
1023087855

Authorized Person:

Name:
MRS. FERMIKA SMITH
Role:
BILLING MANAGER
Phone:

Taxonomy:

Selected Taxonomy:
332B00000X - Durable Medical Equipment & Medical Supplies
Is Primary:
No
Selected Taxonomy:
332BN1400X - Nursing Facility Supplies (DME)
Is Primary:
No
Selected Taxonomy:
332BP3500X - Parenteral & Enteral Nutrition Supplies (DME)
Is Primary:
No
Selected Taxonomy:
332BC3200X - Customized Equipment (DME)
Is Primary:
No
Selected Taxonomy:
332BX2000X - Oxygen Equipment & Supplies (DME)
Is Primary:
No

Contacts:

Fax:
6016384979

Form 5500 Series

Employer Identification Number (EIN):
721380629
Plan Year:
2015
Number Of Participants:
33
Sponsors Telephone Number:
Plan Year:
2014
Number Of Participants:
34
Sponsors Telephone Number:
Plan Year:
2013
Number Of Participants:
37
Sponsors Telephone Number:

Filings

Type Status Filed Date Description
Admin Dissolution Filed 2015-12-08 Admin Dissolution: AR
Notice to Dissolve/Revoke Filed 2015-09-16 Notice to Dissolve/Revoke
Annual Report Filed 2014-02-20 Annual Report
Annual Report Filed 2013-07-30 Annual Report
Notice to Dissolve/Revoke Filed 2013-07-01 Notice to Dissolve/Revoke
Annual Report Filed 2012-11-27 Annual Report
Notice to Dissolve/Revoke Filed 2012-09-13 Notice to Dissolve/Revoke
Annual Report Filed 2011-04-13 Annual Report
Annual Report Filed 2010-03-23 Annual Report
Annual Report Filed 2009-04-13 Annual Report

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Date of last update: 01 May 2025

Sources: Company Profile on Mississippi Secretary of State Website