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EYE CARE SURGERY CENTER OF SOUTHAVEN, LLC

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Company Details

Name: EYE CARE SURGERY CENTER OF SOUTHAVEN, LLC
Jurisdiction: MISSISSIPPI
Business Type: Limited Liability Company
Status: Good Standing
Effective Date: 19 Sep 2003 (22 years ago)
Business ID: 739445
ZIP code: 38671
County: DeSoto
State of Incorporation: MISSISSIPPI
Principal Office Address: 7600 AIRWAYS BLVD SUITE CSOUTHAVEN, MS 38671

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 7600 Airways Blvd, Suite C & D, Southaven, MS 38671

National Provider Identifier

NPI Number:
1780767673
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:
6623497478

Filings

Type Status Filed Date Description
Annual Report LLC Filed 2025-05-06 Annual Report For EYE CARE SURGERY CENTER OF SOUTHAVEN, LLC
Amendment Form Filed 2025-02-03 Amendment For EYE CARE SURGERY CENTER OF SOUTHAVEN, LLC
Annual Report LLC Filed 2025-02-03 Annual Report For EYE CARE SURGERY CENTER OF SOUTHAVEN, LLC
Annual Report LLC Filed 2024-10-09 Annual Report For EYE CARE SURGERY CENTER OF SOUTHAVEN, LLC
Notice to Dissolve/Revoke Filed 2024-09-01 Notice of Intent to Dissolve: AR: EYE CARE SURGERY CENTER OF SOUTHAVEN, LLC
Registered Agent Change of Address Filed 2023-11-20 Agent Address Change For Gregory Thomas Brown
Annual Report LLC Filed 2023-04-06 Annual Report For EYE CARE SURGERY CENTER OF SOUTHAVEN, LLC
Annual Report LLC Filed 2022-03-21 Annual Report For EYE CARE SURGERY CENTER OF SOUTHAVEN, LLC
Annual Report LLC Filed 2021-04-01 Annual Report For EYE CARE SURGERY CENTER OF SOUTHAVEN, LLC
Annual Report LLC Filed 2020-09-22 Annual Report For EYE CARE SURGERY CENTER OF SOUTHAVEN, LLC

OSHA's Inspections within Industry

Inspection Summary

Date:
2013-03-13
Type:
Planned
Address:
7600 AIRWAYS BLVE, SOUTHAVEN, MS, 38671
Safety Health:
Health
Scope:
Complete

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Date of last update: 12 May 2025

Sources: Company Profile on Mississippi Secretary of State Website