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FAIRMOUNT FAMILY MEDICINE, PLLC

Company Details

Name: FAIRMOUNT FAMILY MEDICINE, PLLC
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE LIMITED LIABILITY COMPANY
Status: Active
Date of registration: 01 May 2002 (23 years ago)
Entity Number: 2761178
ZIP code: 13215
County: Onondaga
Place of Formation: New York
Address: 4883 MANOR HILL DR, SYRACUSE, NY, United States, 13215

DOS Process Agent

Name Role Address
FAIRMOUNT FAMILY MEDICINE, PLLC DOS Process Agent 4883 MANOR HILL DR, SYRACUSE, NY, United States, 13215

National Provider Identifier

NPI Number:
1659491421
Certification Date:
2023-11-29

Authorized Person:

Name:
DR. LELAND J JACKSON
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
207Q00000X - Family Medicine Physician
Is Primary:
Yes

Contacts:

Fax:
3152340697

Form 5500 Series

Employer Identification Number (EIN):
043670426
Plan Year:
2017
Number Of Participants:
8
Sponsors Telephone Number:

History

Start date End date Type Value
2008-09-24 2024-09-13 Address 4883 MANOR HILL DR, SYRACUSE, NY, 13215, USA (Type of address: Service of Process)
2004-04-28 2008-09-24 Address 5006 W GENESEE ST, CAMILLUS, NY, 13031, USA (Type of address: Service of Process)
2002-05-01 2004-04-28 Address 111 EAGLE CREST DRIVE, CAMILLUS, NY, 13031, USA (Type of address: Service of Process)

Filings

Filing Number Date Filed Type Effective Date
240913003228 2024-09-13 BIENNIAL STATEMENT 2024-09-13
200805061403 2020-08-05 BIENNIAL STATEMENT 2020-05-01
180509006509 2018-05-09 BIENNIAL STATEMENT 2018-05-01
160525006014 2016-05-25 BIENNIAL STATEMENT 2016-05-01
140620006383 2014-06-20 BIENNIAL STATEMENT 2014-05-01

USAspending Awards / Financial Assistance

Date:
2020-04-15
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO AID SMALL BUSINESSES IN MAINTAINING WORK FORCE DURING COVID-19 PANDEMIC.
Obligated Amount:
0.00
Face Value Of Loan:
76217.00
Total Face Value Of Loan:
76217.00

Paycheck Protection Program

Date Approved:
2020-04-15
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Initial Approval Amount:
76217
Current Approval Amount:
76217
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Unanswered
Veteran:
Unanswered
Forgiveness Amount:
76949.94

Date of last update: 30 Mar 2025

Sources: New York Secretary of State