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NORTH DELTA MEDICINE CLINIC P A

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Company Details

Name: NORTH DELTA MEDICINE CLINIC P A
Jurisdiction: MISSISSIPPI
Business Type: Profit Corporation
Status: Dissolved
Effective Date: 11 Dec 2002 (22 years ago)
Business ID: 726287
State of Incorporation: MISSISSIPPI

Agent

Name Role Address
WILLIAM H GRESHAM JR Agent 144 SUNFLOWER AVE, PO DRAWER 760, CLARKSDALE, MS 38614

Incorporator

Name Role Address
WILLIAM H GRESHAM JR Incorporator 144 SUNFLOWER AVE, PO BOX 760, CLARKSDALE, MS 38614

National Provider Identifier

NPI Number:
1780778571

Authorized Person:

Name:
DR. KENNETH WAYNE KELLOUGH
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
207R00000X - Internal Medicine Physician
Is Primary:
Yes

Contacts:

Fax:
6626212314

Filings

Type Status Filed Date Description
Admin Dissolution Filed 2003-12-30 Admin Dissolution
Notice to Dissolve/Revoke Filed 2003-10-22 Notice to Dissolve/Revoke
Name Reservation Form Filed 2002-12-11 Name Reservation

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Date of last update: 05 May 2025

Sources: Company Profile on Mississippi Secretary of State Website