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  5. MISSION PRIMARY CARE CLINIC, PLLC

MISSION PRIMARY CARE CLINIC, PLLC

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Company Details

Name: MISSION PRIMARY CARE CLINIC, PLLC
Jurisdiction: MISSISSIPPI
Business Type: Limited Liability Company
Status: Good Standing
Effective Date: 04 Nov 1998 (27 years ago)
Business ID: 663109
ZIP code: 39180
County: Warren
State of Incorporation: MISSISSIPPI
Principal Office Address: 1901 Mission 66, 1901 Mission 66Vicksburg, MS 39180

Agent

Name Role Address
R LEE GIFFIN Agent 1901 MISSION 66, VICKSBURG, MS 39180

Member

Name Role Address
R Lee Giffin Member 1901 MISSION 66, VICKSBURG, MS 39180

U.S. Small Business Administration Profile

Website:
missionprimary.com
Phone Number:
601-636-0097
E-mail Address:
fulcher@missionprimary.com
Contact Person:
WILLIAM FULCHER
Ownership and Self-Certifications:
Self-Certified Small Disadvantaged Business
User ID:
P3164284

Unique Entity ID

Unique Entity ID:
RH6SKAX3DMW9
CAGE Code:
1UA78
UEI Expiration Date:
2026-01-28

Business Information

URL:
missionprimary.com
Division Name:
MISSION PRIMARY CARE CLINIC PLLC
Activation Date:
2025-01-30
Initial Registration Date:
2001-06-13

National Provider Identifier

NPI Number:
1487852018
Certification Date:
2022-05-25
Link:
View on NPI website

Authorized Person:

Name:
BILL FULCHER
Role:
ADM
Phone:
6016360097

Taxonomy:

Selected Taxonomy:
363LF0000X - Family Nurse Practitioner
Is Primary:
No
Selected Taxonomy:
207Q00000X - Family Medicine Physician
Is Primary:
Yes

Contacts:

Phone:
+1 601-636-0097
Fax:
6016299969

Form 5500 Series

Employer Identification Number (EIN):
640862084
Plan Year:
2023
Number Of Participants:
24
Sponsors Telephone Number:
6016360097
File:
View File
Plan Year:
2022
Number Of Participants:
23
Sponsors Telephone Number:
6016360097
File:
View File
Plan Year:
2021
Number Of Participants:
24
Sponsors Telephone Number:
6016360097
File:
View File
Plan Year:
2020
Number Of Participants:
23
Sponsors Telephone Number:
6016360097
File:
View File
Plan Year:
2019
Number Of Participants:
26
Sponsors Telephone Number:
6016360097
File:
View File

Filings

Type Status Filed Date Description
Annual Report LLC Filed 2025-04-15 Annual Report For MISSION PRIMARY CARE CLINIC, PLLC
Annual Report LLC Filed 2024-01-23 Annual Report For MISSION PRIMARY CARE CLINIC, PLLC
Annual Report LLC Filed 2023-04-18 Annual Report For MISSION PRIMARY CARE CLINIC, PLLC
Annual Report LLC Filed 2023-03-09 Annual Report For MISSION PRIMARY CARE CLINIC, PLLC
Annual Report LLC Filed 2022-04-21 Annual Report For MISSION PRIMARY CARE CLINIC, PLLC
Annual Report LLC Filed 2021-04-12 Annual Report For MISSION PRIMARY CARE CLINIC, PLLC
Annual Report LLC Filed 2020-04-24 Annual Report For MISSION PRIMARY CARE CLINIC, PLLC
Annual Report LLC Filed 2019-04-15 Annual Report For MISSION PRIMARY CARE CLINIC, PLLC
Annual Report LLC Filed 2018-04-13 Annual Report For MISSION PRIMARY CARE CLINIC, PLLC
Annual Report LLC Filed 2017-03-28 Annual Report For MISSION PRIMARY CARE CLINIC, PLLC

USAspending Awards / Contracts

Procurement Instrument Identifier:
W912HZ24C0063
Link:
View Award on USAspending website
Award Or Idv Flag:
AWARD
Award Type:
DEFINITIVE CONTRACT
Action Obligation:
62400.00
Base And Exercised Options Value:
62400.00
Base And All Options Value:
343200.00
Awarding Agency Name:
Department of Defense
Performance Start Date:
2024-07-24
Description:
BASE YEAR - PHYSICIAN SERVICES
Naics Code:
621111: OFFICES OF PHYSICIANS (EXCEPT MENTAL HEALTH SPECIALISTS)
Product Or Service Code:
Q999: MEDICAL- OTHER
Procurement Instrument Identifier:
W912EE23P0089
Link:
View Award on USAspending website
Award Or Idv Flag:
AWARD
Award Type:
PURCHASE ORDER
Action Obligation:
99400.00
Base And Exercised Options Value:
99400.00
Base And All Options Value:
503000.00
Awarding Agency Name:
Department of Defense
Performance Start Date:
2023-08-18
Description:
PHYSICIAN SERVICES
Naics Code:
621111: OFFICES OF PHYSICIANS (EXCEPT MENTAL HEALTH SPECIALISTS)
Product Or Service Code:
Q201: MEDICAL- GENERAL HEALTH CARE
Procurement Instrument Identifier:
W912EE23P0090
Link:
View Award on USAspending website
Award Or Idv Flag:
AWARD
Award Type:
PURCHASE ORDER
Action Obligation:
7500.00
Base And Exercised Options Value:
7500.00
Base And All Options Value:
37500.00
Awarding Agency Name:
Department of Defense
Performance Start Date:
2023-08-18
Description:
LABORATORY BLOOD TESTING SERVICES FOR USACE-MVK.
Naics Code:
621511: MEDICAL LABORATORIES
Product Or Service Code:
Q301: MEDICAL- LABORATORY TESTING

USAspending Awards / Financial Assistance

Date:
2021-02-23
Link:
View on USAspending
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO AID SMALL BUSINESSES IN MAINTAINING WORK FORCE DURING COVID-19 PANDEMIC.
Obligated Amount:
0.00
Face Value Of Loan:
338570.00
Total Face Value Of Loan:
338570.00
Date:
2020-04-14
Link:
View on USAspending
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO AID SMALL BUSINESSES IN MAINTAINING WORK FORCE DURING COVID-19 PANDEMIC.
Obligated Amount:
0.00
Face Value Of Loan:
336007.50
Total Face Value Of Loan:
336007.50

OSHA's Inspections within Industry

Inspection Summary

Date:
2011-09-08
Type:
Planned
Address:
1901 MISSION 66, VICKSBURG, MS, 39180
Safety Health:
Health
Scope:
Complete
Inspection Link:
View Inspection data on OSHA website

Paycheck Protection Program

Jobs Reported:
40
Initial Approval Amount:
$338,570
Date Approved:
2021-02-23
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$338,570
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Unanswered
Veteran:
Unanswered
Forgiveness Amount:
$341,111.59
Servicing Lender:
Loan Source Incorporated
Use of Proceeds:
Payroll: $338,570
Jobs Reported:
40
Initial Approval Amount:
$336,007.5
Date Approved:
2020-04-14
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$336,007.5
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Unanswered
Veteran:
Unanswered
Forgiveness Amount:
$338,704.89
Servicing Lender:
Cadence Bank
Use of Proceeds:
Payroll: $336,007.5

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Related by officers

R LEE GIFFIN

MISSION PRIMARY CARE REAL ESTATE, LLC

R Lee Giffin

MISSION PRIMARY CARE REAL ESTATE, LLC

Related by address

1901 Mission 66, 1901 Mission 66Vicksburg, MS 39180

R.L.G., M.D., P.A. MISSION PRIMARY CARE REAL ESTATE, LLC Joseph L. Wilson MD Inc. Denesia Y Giffin PLLC Medically Heard, LLC

Date of last update: 22 Jun 2025

Sources: Company Profile on Mississippi Secretary of State Website

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