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Cedar Lake Pediatric Clinic, PLLC

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Company Details

Name: Cedar Lake Pediatric Clinic, PLLC
Jurisdiction: MISSISSIPPI
Business Type: Limited Liability Company
Status: Dissolved
Effective Date: 15 Aug 2005 (20 years ago)
Business ID: 876706
State of Incorporation: MISSISSIPPI

Agent

Name Role Address
Hoff, Frederick T, Jr Agent 2019 23Rd Avenue;P O Box 910, Gulfport, MS 39501

Member

Name Role Address
Elisabeth J. Haller Member 14 Kimball Drive, Gulfport, MS 39507

National Provider Identifier

NPI Number:
1497826044

Authorized Person:

Name:
DR. LISA J HALLER
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
208000000X - Pediatrics Physician
Is Primary:
Yes

Contacts:

Fax:
2283960687

Filings

Type Status Filed Date Description
Failure to File AR Filed 2011-12-05 Failure to File AR
Amendment Form Filed 2006-03-13 Amendment
Formation Form Filed 2005-08-15 Formation

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Date of last update: 25 Jun 2025

Sources: Company Profile on Mississippi Secretary of State Website