| Entity Name: | JACKSONVILLE BEACHES MEDICAL IMAGING, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Profit |
| Status: |
Inactive
The business entity is inactive. This status may signal operational issues or voluntary closure, raising concerns about the business's ability to repay loans and requiring careful risk assessment by lenders. |
| Date Filed: | 10 Apr 2000 (25 years ago) |
| Date of dissolution: | 23 Sep 2016 (8 years ago) |
| Last Event: | REVOKED FOR ANNUAL REPORT |
| Event Date Filed: | 23 Sep 2016 (8 years ago) |
| Document Number: | F00000002066 |
| FEI/EIN Number |
522224844
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 8302 Dunwoody Place, Suite 200, Atlanta, GA, 30350, US |
| Mail Address: | 8302 DUNWOODY PLACE, SUITE 200, ATLANTA, GA, 30350, US |
| Place of Formation: | GEORGIA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1548257041 | 2005-09-30 | 2012-10-02 | 2700 RIVERSIDE AVE, SUITE 1, JACKSONVILLE, FL, 322058275, US | 2700 RIVERSIDE AVE, SUITE 1, JACKSONVILLE, FL, 322058275, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 904-381-9994 |
| Fax | 9043896866 |
Authorized person
| Name | MRS. CATHY BLAESE |
| Role | CHIEF OPERATING OFFICER |
| Phone | 9042417772 |
Taxonomy
| Taxonomy Code | 261QR0200X - Radiology Clinic/Center |
| License Number | HCCR1430 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | 1ST HEALTH PROVIDER # |
| Number | 1840590 |
| State | FL |
| Issuer | UNITED HEALTH CARE |
| Number | 2000441 |
| State | FL |
| Issuer | RR MEDICARE PROVIDER # |
| Number | 470001666 |
| State | FL |
| Issuer | BCBS FL PIN # |
| Number | V2622 |
| State | FL |
| Issuer | 1ST HEALTH W/C # |
| Number | 147878902 |
| State | FL |
| Issuer | AETNA PROVIDER # |
| Number | 7842141 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CARL ROBERT D | Chairman | 8300 DUNWOODY PLACE, SUITE 209, ATLANTA, GA, 303503304 |
| CARL ROBERT D | President | 8300 DUNWOODY PLACE, SUITE 209, ATLANTA, GA, 303503304 |
| CARL ROBERT D | Secretary | 8300 DUNWOODY PLACE, SUITE 209, ATLANTA, GA, 303503304 |
| CARL ROBERT D | Treasurer | 8300 DUNWOODY PLACE, SUITE 209, ATLANTA, GA, 303503304 |
| LEO REBECCA H | ASAT | 8302 DUNWOODY PLACE, SUITE200, ATLANTA, GA, 30350 |
| Morgan Lisa C | Agent | 1170 19th Street North, JACKSONVILLE BEACH, FL, 32250 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G12000064843 | JACKSONVILLE MEDICAL IMAGING | EXPIRED | 2012-06-28 | 2017-12-31 | - | 3316 S. THIRD ST., STE-101, JACKSONVILLE BEACH, FL, 32250 |
| G12000064844 | SOUTHSIDE MEDICAL IMAGING | EXPIRED | 2012-06-28 | 2017-12-31 | - | 3316 S. THIRD ST., STE-101, JACKSONVILLE BEACH, FL, 32250 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REVOKED FOR ANNUAL REPORT | 2016-09-23 | - | - |
| CHANGE OF PRINCIPAL ADDRESS | 2015-02-12 | 8302 Dunwoody Place, Suite 200, Atlanta, GA 30350 | - |
| REGISTERED AGENT NAME CHANGED | 2015-02-12 | Morgan, Lisa COO | - |
| REGISTERED AGENT ADDRESS CHANGED | 2015-02-12 | 1170 19th Street North, JACKSONVILLE BEACH, FL 32250 | - |
| CHANGE OF MAILING ADDRESS | 2001-05-04 | 8302 Dunwoody Place, Suite 200, Atlanta, GA 30350 | - |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2015-02-12 |
| ANNUAL REPORT | 2014-01-07 |
| ANNUAL REPORT | 2013-03-21 |
| ANNUAL REPORT | 2012-04-10 |
| ANNUAL REPORT | 2011-03-24 |
| ANNUAL REPORT | 2010-01-07 |
| ANNUAL REPORT | 2009-01-06 |
| ANNUAL REPORT | 2008-04-10 |
| ANNUAL REPORT | 2007-01-26 |
| ANNUAL REPORT | 2006-04-10 |
Date of last update: 02 Mar 2025
Sources: Florida Department of State
