| Entity Name: | MAGELLAN PROVIDER SERVICES, P.A., P.C. |
| Jurisdiction: | Connecticut |
| Legal type: | Stock |
| Citizenship: | Foreign |
| Status: | Active |
| Sub status: | Annual report due |
| Date Formed: | 14 Mar 2022 |
| Business ALEI: | 2491298 |
| Annual report due: | 14 Mar 2025 |
| NAICS code: | 621111 - Offices of Physicians (except Mental Health Specialists) |
| Business address: | 6303 COWBOYS WAY, SUITE 350, FRISCO, TX, 75034, United States |
| Mailing address: | 8621 ROBERT FULTON DRIVE, COLUMBIA, MD, United States, 21046 |
| Place of Formation: | FLORIDA |
| E-Mail: | shannon.p.kister@centene.com |
| Name | Role |
|---|---|
| CORPORATION SERVICE COMPANY | Agent |
| Name | Role | Business address | Residence address |
|---|---|---|---|
| BRANTLEY TILMAN JOLLY, JR., M.D. | Officer | 8621 ROBERT FULTON DR., COLUMBIA, MD, 21046, United States | 1539 BROOKHAVEN DRIVE, MCLEAN, VA, 22101, United States |
| Name | Role | Business address | Residence address |
|---|---|---|---|
| BRANTLEY TILMAN JOLLY, JR., M.D. | Director | 8621 ROBERT FULTON DR., COLUMBIA, MD, 21046, United States | 1539 BROOKHAVEN DRIVE, MCLEAN, VA, 22101, United States |
| Filing number | Filing date | Effective date | Filing category | Filing type | Report year |
|---|---|---|---|---|---|
| BF-0012310985 | 2024-03-12 | No data | Annual Report | Annual Report | No data |
| BF-0011512692 | 2023-03-13 | No data | Annual Report | Annual Report | No data |
| BF-0010506515 | 2022-03-14 | 2022-03-14 | Business Registration | Certificate of Authority | No data |
Date of last update: 25 Nov 2024
Sources: Connecticut's Official State Website
