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LAKE CHAMPLAIN PHYSICIAN SERVICES, P.C.

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Company Details

Name: LAKE CHAMPLAIN PHYSICIAN SERVICES, P.C.
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE CORPORATION
Status: Active
Date of registration: 25 Oct 2010 (15 years ago)
Entity Number: 4010801
ZIP code: 12901
County: Clinton
Place of Formation: New York
Address: 75 BEEKMAN STREET, Plattsburgh, NY, United States, 12901
Principal Address: 75 BEEKMAN STREET, PLATTSBURGH, NY, United States, 12901

Shares Details

Shares issued 200

Share Par Value 0

Type NO PAR VALUE

DOS Process Agent

Name Role Address
LAKE CHAMPLAIN PHYSICIAN SERVICES, P.C. DOS Process Agent 75 BEEKMAN STREET, Plattsburgh, NY, United States, 12901

Chief Executive Officer

Name Role Address
LISA MARK, M.D., FACS Chief Executive Officer 75 BEEKMAN STREET, PLATTSBURGH, NY, United States, 12901

National Provider Identifier

NPI Number:
1083915268

Authorized Person:

Name:
DR. WOUTER RIETSEMA
Role:
PRESIDENT
Phone:

Taxonomy:

Selected Taxonomy:
207RC0000X - Cardiovascular Disease Physician
Is Primary:
No
Selected Taxonomy:
207R00000X - Internal Medicine Physician
Is Primary:
Yes

Contacts:

Fax:
5185627542

History

Start date End date Type Value
2024-10-01 2024-10-01 Address 75 BEEKMAN STREET, PLATTSBURGH, NY, 12901, USA (Type of address: Chief Executive Officer)
2012-10-23 2024-10-01 Address 75 BEEKMAN STREET, PLATTSBURGH, NY, 12901, USA (Type of address: Chief Executive Officer)
2012-10-23 2024-10-01 Address 52 TOM MILLER ROAD, PLATTSBURGH, NY, 12901, USA (Type of address: Service of Process)
2010-10-25 2012-10-23 Address 75 BEEKMAN STREET, PLATTSBURGH, NY, 12901, USA (Type of address: Service of Process)
2010-10-25 2024-10-01 Shares Share type: NO PAR VALUE, Number of shares: 200, Par value: 0

Filings

Filing Number Date Filed Type Effective Date
241001037621 2024-10-01 BIENNIAL STATEMENT 2024-10-01
221114000079 2022-11-14 BIENNIAL STATEMENT 2022-10-01
211216000635 2021-12-16 BIENNIAL STATEMENT 2021-12-16
161003006671 2016-10-03 BIENNIAL STATEMENT 2016-10-01
141002006788 2014-10-02 BIENNIAL STATEMENT 2014-10-01

Tax Exempt

Employer Identification Number (EIN) :
27-3785445
Classification:
Government Instrumentality, Title-Holding Corporation, Charitable Organization, Agricultural Organization, Board of Trade, Pleasure, Recreational, or Social Club, Fraternal Beneficiary Society, Order or Association, Voluntary Employees' Beneficiary Association (Non-Govt. Emps.), Domestic Fraternal Societies and Associations, Teachers Retirement Fund Assoc., Benevolent Life Insurance Assoc., Burial Association, Credit Union, Mutual Insurance Company or Assoc. Other Than Life or Marine, Corp. Financing Crop Operations, Supplemental Unemployment Compensation Trust or Plan, Employee Funded Pension Trust (Created Before 6/25/59), Post or Organization of War Veterans, Legal Service Organization, Black Lung Trust, Multiemployer Pension Plan, Veterans Assoc. Formed Prior to 1880, Trust Described in Sect. 4049 of ERISA, Title Holding Co. for Pensions, etc., State-Sponsored High Risk Health Insurance Organizations, State-Sponsored Workers' Compensation Reinsurance, ACA 1322 Qualified Nonprofit Health Insurance Issuers, Apostolic and Religious Org. (501(d)), Cooperative Hospital Service Organization (501(e)), Cooperative Service Organization of Operating Educational Organization (501(f)), Child Care Organization (501(k)), Charitable Risk Pool, Qualified State-Sponsored Tuition Program, 4947(a)(1) - Private Foundation (Form 990PF Filer)
Ruling Date:
2013-12
National Taxonomy Of Exempt Entities:
Health Care: Health Support Services
Deductibility:
Type of organization and use of contribution: A supporting organization, unspecified type. Deductibility Limitation: 50% (60% for cash contributions)

Determination Letters

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Date of last update: 27 Mar 2025

Sources: New York Secretary of State