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GREEN TREE FAMILY MEDICAL CLINIC, PLLC

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Company Details

Name: GREEN TREE FAMILY MEDICAL CLINIC, PLLC
Jurisdiction: MISSISSIPPI
Business Type: Limited Liability Company
Status: Dissolved
Effective Date: 31 Aug 1999 (26 years ago)
Business ID: 675365
ZIP code: 39119
County: Covington
State of Incorporation: MISSISSIPPI
Principal Office Address: 603 S MAIN STMOUNT OLIVE, MS 39119

Agent

Name Role Address
W.M. JOHNSTON Agent 603 MAIN ST, MOUNT OLIVE, MS 39119

Member

Name Role Address
W.M. JOHNSTON Member 603 MAIN ST, MOUNT OLIVE, MS 39119
Johnston Word Member BOX 1107, MOUNT OLIVE, MS 39119

Manager

Name Role Address
Word Johnston Manager BOX 1107, MOUNT OLIVE, MS 39119

National Provider Identifier

NPI Number:
1770741191

Authorized Person:

Name:
MS. KATHY M BYNUM
Role:
CLINIC DIRECTOR
Phone:

Taxonomy:

Selected Taxonomy:
261QR1300X - Rural Health Clinic/Center
Is Primary:
Yes

Contacts:

Fax:
6017973405
Fax:
6017974707

Filings

Type Status Filed Date Description
Dissolution Filed 2013-09-25 Dissolution
Annual Report LLC Filed 2012-03-28 Annual Report LLC
Annual Report LLC Filed 2011-03-17 Annual Report LLC
Name Reservation Form Filed 1999-08-31 Name Reservation

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Date of last update: 03 May 2025

Sources: Company Profile on Mississippi Secretary of State Website