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CEDAR LAKE MEDICAL CENTER, P.A.

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Company Details

Name: CEDAR LAKE MEDICAL CENTER, P.A.
Jurisdiction: MISSISSIPPI
Business Type: Profit Corporation
Status: Dissolved
Effective Date: 29 Sep 1997 (28 years ago)
Business ID: 647435
ZIP code: 39532
County: Harrison
State of Incorporation: MISSISSIPPI
Principal Office Address: 1759 MEDICAL PARK DRBILOXI, MS 39532

Agent

Name Role Address
RICKEY L CHANCE Agent 1759 MEDICAL PARK DR, BILOXI, MS 39532

Incorporator

Name Role Address
Rickey L Chance Incorporator 4 Schooner Ln, Ocean Springs, MS 39564

Director

Name Role Address
Rickey L Chance Director 1610 Girvan Court, Ocean Springs, MS 39564

President

Name Role Address
Rickey L Chance President 1610 Girvan Court, Ocean Springs, MS 39564

Unique Entity ID

CAGE Code:
7NVQ4
UEI Expiration Date:
2017-07-25

Business Information

Doing Business As:
CHANCE, RICKEY L DR
Division Name:
CEDAR LAKE MEDICAL CENTER PA
Activation Date:
2016-07-25
Initial Registration Date:
2016-07-05

Commercial and government entity program

CAGE number:
7NVQ4
Status:
Obsolete
Type:
Non-Manufacturer
CAGE Update Date:
2022-08-02
CAGE Expiration:
2022-08-01

Contact Information

POC:
RICKEY CHANCE
Corporate URL:
www.cedarlakemedical.com

National Provider Identifier

NPI Number:
1508068230

Authorized Person:

Name:
MRS. MARY SEYFARTH
Role:
MANAGER
Phone:

Taxonomy:

Selected Taxonomy:
207Q00000X - Family Medicine Physician
Is Primary:
Yes

Contacts:

Fax:
2283850073

Form 5500 Series

Employer Identification Number (EIN):
721397004
Plan Year:
2016
Number Of Participants:
12
Sponsors Telephone Number:
Plan Year:
2015
Number Of Participants:
12
Sponsors Telephone Number:
Plan Year:
2014
Number Of Participants:
12
Sponsors Telephone Number:
Plan Year:
2013
Number Of Participants:
10
Sponsors Telephone Number:

Filings

Type Status Filed Date Description
Admin Dissolution Filed 2020-11-27 Action of CEDAR LAKE MEDICAL CENTER, P.A.: AR
Notice to Dissolve/Revoke Filed 2020-08-28 Notice to Dissolve/Revoke
Annual Report Filed 2019-06-25 Annual Report For CEDAR LAKE MEDICAL CENTER, P.A.
Annual Report Filed 2018-09-25 Annual Report For CEDAR LAKE MEDICAL CENTER, P.A.
Notice to Dissolve/Revoke Filed 2018-09-07 Notice to Dissolve/Revoke
Annual Report Filed 2017-03-15 Annual Report For CEDAR LAKE MEDICAL CENTER, P.A.
Annual Report Filed 2016-02-09 Annual Report For CEDAR LAKE MEDICAL CENTER, P.A.
Annual Report Filed 2015-04-06 Annual Report For CEDAR LAKE MEDICAL CENTER, P.A.
Annual Report Filed 2014-06-19 Annual Report
Annual Report Filed 2013-06-27 Annual Report

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Date of last update: 21 Jun 2025

Sources: Company Profile on Mississippi Secretary of State Website