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KEITH A. NICHOLS, M.D., PLLC

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Company Details

Name: KEITH A. NICHOLS, M.D., PLLC
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE LIMITED LIABILITY COMPANY
Status: Active
Date of registration: 05 Jul 2005 (20 years ago)
Entity Number: 3226671
ZIP code: 13827
County: Tioga
Place of Formation: New York
Address: 130 TEMPLE STREET / SUITE 100, OWEGO, NY, United States, 13827

DOS Process Agent

Name Role Address
KEITH A NICHOLS, MD DOS Process Agent 130 TEMPLE STREET / SUITE 100, OWEGO, NY, United States, 13827

National Provider Identifier

NPI Number:
1346421211

Authorized Person:

Name:
JANE E NICHOLS
Role:
BUSINESS MANAGER
Phone:

Taxonomy:

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

Contacts:

History

Start date End date Type Value
2011-07-22 2013-07-29 Address 130 TEMPLE STREET / SUITE 100, OWEGO, NY, 13827, USA (Type of address: Service of Process)
2009-07-03 2011-07-22 Address 130 TEMPLE ST SUITE 100, OWEGO, NY, 13827, USA (Type of address: Service of Process)
2005-07-05 2009-07-03 Address 922 MOUNTAIN ROAD, OWEGO, NY, 13826, USA (Type of address: Service of Process)

Filings

Filing Number Date Filed Type Effective Date
150707006032 2015-07-07 BIENNIAL STATEMENT 2015-07-01
130729006334 2013-07-29 BIENNIAL STATEMENT 2013-07-01
110722002017 2011-07-22 BIENNIAL STATEMENT 2011-07-01
090703002391 2009-07-03 BIENNIAL STATEMENT 2009-07-01
070711002027 2007-07-11 BIENNIAL STATEMENT 2007-07-01

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:
24700.00
Total Face Value Of Loan:
24700.00

Paycheck Protection Program

Jobs Reported:
3
Initial Approval Amount:
$24,700
Date Approved:
2020-04-15
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$24,700
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Unanswered
Veteran:
Unanswered
Forgiveness Amount:
$24,875.95
Servicing Lender:
NBT Bank, National Association
Use of Proceeds:
Payroll: $18,525
Utilities: $3,087.5
Mortgage Interest: $3,087.5

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Date of last update: 29 Mar 2025

Sources: New York Secretary of State