| Entity Name: | KOZHIMALA T. JOHN, M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Inactive |
| Date Filed: | 01 Aug 1978 (47 years ago) |
| Date of dissolution: | 23 Sep 2022 (2 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 23 Sep 2022 (2 years ago) |
| Document Number: | 581008 |
| FEI/EIN Number | 59-1829206 |
| Address: | 6340 FORT KING ROAD, ZEPHYRHILLS, FL 33542 |
| Mail Address: | 6340 FORT KING ROAD, P.O. BOX 1617, ZEPHYRHILLS, FL 33539 |
| ZIP code: | 33542 |
| County: | Pasco |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1215206792 | 2011-12-29 | 2018-08-22 | PO BOX 1617, ZEPHYRHILLS, FL, 335391617, US | 6340 FORT KING RD, ZEPHYRHILLS, FL, 33542, US | |||||||||||||||||||||||||||||||||||||
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| Phone | +1 813-782-6116 |
| Fax | 8137801051 |
Authorized person
| Name | DR. KOZHIMALA T JOHN |
| Role | M.D./OWNER |
| Phone | 8137826116 |
Taxonomy
| Taxonomy Code | 207RG0100X - Gastroenterology Physician |
| License Number | ME23148 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | NPI (INDIVIDUAL) |
| Number | 1891890638 |
| State | FL |
| Issuer | MEDICAID |
| Number | 058391000 |
| State | FL |
| Issuer | BC/BS |
| Number | 51086 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| JOHN, K.T. | Agent | 6340 FORT KING ROAD, ZEPHYRHILLS, FL 33542 |
| Name | Role | Address |
|---|---|---|
| JOHN, KOZHIMALA T. | President | 6340 FORT KING RD, ZEPHYRHILLS, FL 33542 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2022-09-23 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2011-09-06 | 6340 FORT KING ROAD, ZEPHYRHILLS, FL 33542 | No data |
| CHANGE OF MAILING ADDRESS | 2011-09-06 | 6340 FORT KING ROAD, ZEPHYRHILLS, FL 33542 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2011-09-06 | 6340 FORT KING ROAD, ZEPHYRHILLS, FL 33542 | No data |
| REGISTERED AGENT NAME CHANGED | 1988-04-05 | JOHN, K.T. | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J21000630693 | TERMINATED | 1000000909442 | PASCO | 2021-12-06 | 2041-12-08 | $ 916.22 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, TAMPA SERVICE CENTER, 5483 W WATERS AVE STE 1210, TAMPA FL336341236 |
| J19000382208 | TERMINATED | 1000000827953 | PASCO | 2019-05-23 | 2039-05-29 | $ 950.24 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, HOLIDAY SERVICE CENTER, 5483 W WATERS AVE STE 1210, TAMPA FL336341236 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2021-04-26 |
| ANNUAL REPORT | 2020-06-19 |
| ANNUAL REPORT | 2019-04-25 |
| ANNUAL REPORT | 2018-04-26 |
| ANNUAL REPORT | 2017-09-22 |
| ANNUAL REPORT | 2016-04-29 |
| ANNUAL REPORT | 2015-04-23 |
| ANNUAL REPORT | 2014-04-02 |
| ANNUAL REPORT | 2013-04-25 |
| ANNUAL REPORT | 2012-03-03 |
Date of last update: 05 Feb 2025
Sources: Florida Department of State
