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PICAYUNE RURAL HEALTH CLINIC, INC.

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Company Details

Name: PICAYUNE RURAL HEALTH CLINIC, INC.
Jurisdiction: MISSISSIPPI
Business Type: Profit Corporation
Status: Dissolved
Effective Date: 19 Feb 1999 (26 years ago)
Business ID: 667199
ZIP code: 39466
County: Pearl River
State of Incorporation: MISSISSIPPI
Principal Office Address: 317 North Main StreetPicayune, MS 39466

Agent

Name Role Address
KRISTA K WADE Agent 1003 6TH AVE, PICAYUNE, MS 39466

Secretary

Name Role Address
Ahmad A Haidar MD Secretary 317 North Main Street, Picayune, MS 39466

Vice President

Name Role Address
Ahmad A Haidar MD Vice President 317 North Main Street, Picayune, MS 39466

Director

Name Role Address
Krista K Hodge, FNP Director 317 North Main Street, Picayune, MS 39466

President

Name Role Address
Krista K Hodge, FNP President 317 North Main Street, Picayune, MS 39466

Incorporator

Name Role Address
Ashraf Tabatabaii Incorporator 421 River Rd, Picayune, MS 39466
Ahmad A Haidar MD Incorporator 1003 6th Ave, Picayune, MS 39466
Krista K Wade Incorporator 109 Gumpond-beall Rd, Lumberton, MS 39455

National Provider Identifier

NPI Number:
1700983913

Authorized Person:

Name:
KRISTA KAY HODGE
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
207R00000X - Internal Medicine Physician
Is Primary:
No
Selected Taxonomy:
363L00000X - Nurse Practitioner
Is Primary:
Yes

Contacts:

Fax:
6017995444

Filings

Type Status Filed Date Description
Admin Dissolution Filed 2010-12-06 Admin Dissolution
Notice to Dissolve/Revoke Filed 2010-09-12 Notice to Dissolve/Revoke
Annual Report Filed 2009-08-20 Annual Report
Annual Report Filed 2008-07-25 Annual Report
Annual Report Filed 2007-11-05 Annual Report
Notice to Dissolve/Revoke Filed 2007-10-16 Notice to Dissolve/Revoke
Annual Report Filed 2006-06-14 Annual Report
Annual Report Filed 2005-05-20 Annual Report
Annual Report Filed 2004-06-14 Annual Report
Annual Report Filed 2003-09-10 Annual Report

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Date of last update: 22 Jun 2025

Sources: Company Profile on Mississippi Secretary of State Website