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EYE CARE SURGERY CENTER OF OLIVE BRANCH, LLC

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Company Details

Name: EYE CARE SURGERY CENTER OF OLIVE BRANCH, LLC
Jurisdiction: MISSISSIPPI
Business Type: Limited Liability Company
Status: Good Standing
Effective Date: 10 Jun 2003 (22 years ago)
Business ID: 734821
ZIP code: 38654
County: DeSoto
State of Incorporation: MISSISSIPPI
Principal Office Address: 6947 CRUMPLER BLVD.OLIVE BRANCH, MS 38654

Manager

Name Role Address
Provident ASC Holdings, LLC Manager 825 Ridge Lake Blvd, Memphis, TN 38120

Member

Name Role Address
Provident ASC Holdings, LLC Member 825 Ridge Lake Blvd, Memphis, TN 38120

Agent

Name Role Address
Teressa Thompson Agent 6947 Crumpler Blvd, STE 105, Olive Branch, MS 38654

National Provider Identifier

NPI Number:
1720161771
Certification Date:
2022-07-25

Authorized Person:

Name:
DR. SUBBA R. GOLLAMUDI
Role:
MEDICAL DIRECTOR
Phone:

Taxonomy:

Selected Taxonomy:
261QA1903X - Ambulatory Surgical Clinic/Center
Is Primary:
Yes

Contacts:

Fax:
9012555631
Fax:
6628933306

Filings

Type Status Filed Date Description
Amendment Form Filed 2025-02-03 Amendment For EYE CARE SURGERY CENTER OF OLIVE BRANCH, LLC
Annual Report LLC Filed 2025-02-03 Annual Report For EYE CARE SURGERY CENTER OF OLIVE BRANCH, LLC
Reinstatement Filed 2024-12-16 Reinstatement For EYE CARE SURGERY CENTER OF OLIVE BRANCH, LLC
Admin Dissolution Filed 2024-12-01 Action of Intent to Dissolve: AR: EYE CARE SURGERY CENTER OF OLIVE BRANCH, LLC
Notice to Dissolve/Revoke Filed 2024-09-01 Notice of Intent to Dissolve: AR: EYE CARE SURGERY CENTER OF OLIVE BRANCH, LLC
Annual Report LLC Filed 2023-04-06 Annual Report For EYE CARE SURGERY CENTER OF OLIVE BRANCH, LLC
Annual Report LLC Filed 2022-03-21 Annual Report For EYE CARE SURGERY CENTER OF OLIVE BRANCH, LLC
Annual Report LLC Filed 2021-04-01 Annual Report For EYE CARE SURGERY CENTER OF OLIVE BRANCH, LLC
Annual Report LLC Filed 2020-09-22 Annual Report For EYE CARE SURGERY CENTER OF OLIVE BRANCH, LLC
Notice to Dissolve/Revoke Filed 2020-08-28 Notice to Dissolve/Revoke

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Date of last update: 12 May 2025

Sources: Company Profile on Mississippi Secretary of State Website