| Entity Name: | AMERICAN DIAGNOSTIC MEDICINE, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Profit |
| Status: | Inactive |
| Date Filed: | 02 Jan 2001 (24 years ago) |
| Branch of: | AMERICAN DIAGNOSTIC MEDICINE, INC., ILLINOIS (Company Number CORP_53715893) |
| Date of dissolution: | 23 Sep 2011 (13 years ago) |
| Last Event: | REVOKED FOR ANNUAL REPORT |
| Event Date Filed: | 23 Sep 2011 (13 years ago) |
| Document Number: | F01000000029 |
| FEI/EIN Number | 363351715 |
| Address: | 3537 NO. LECANTO HIGHWAY, BEVERLY HILLS, FL, 34465 |
| Mail Address: | 960 INDUSTRIAL DR., STE 7, ELMHURST, IL, 60126 |
| ZIP code: | 34465 |
| County: | Citrus |
| Place of Formation: | ILLINOIS |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1700994910 | 2006-08-28 | 2020-08-22 | PO BOX 6465, TITUSVILLE, FL, 327826465, US | 3537 N LECANTO HWY, BEVERLY HILLS, FL, 344653502, US | |||||||||||||||||||||||||
|
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| Phone | +1 352-527-9333 |
| Fax | 3525272482 |
Authorized person
| Name | HECTOR RIVERA |
| Role | TECHNOLOGIST/MANAGER |
| Phone | 3525279333 |
Taxonomy
| Taxonomy Code | 261QM1200X - Magnetic Resonance Imaging (MRI) Clinic/Center |
| License Number | HCC5650 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE SHIELD |
| Number | V2381 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| RIVERA HECTOR | Agent | 3537 NO. LECANTO HIGHWAY, BEVERLY HILLS, FL, 34465 |
| Name | Role | Address |
|---|---|---|
| KANCHERLAPALLI SAM | President | 960 INDUSTRIAL DR STE 7, ELMHURST, IL, 60126 |
| Name | Role | Address |
|---|---|---|
| KANCHERLAPALLI ANAND | Vice President | 960 INDUSTRIAL DR STE 7, ELMHURST, IL, 60126 |
| Name | Role | Address |
|---|---|---|
| KANCHERLAPALLI SAM | Secretary | 960 INDUSTRIAL DR STE 7, ELMHURST, IL, 60126 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REVOKED FOR ANNUAL REPORT | 2011-09-23 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2009-05-28 | 3537 NO. LECANTO HIGHWAY, BEVERLY HILLS, FL 34465 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2009-05-28 | 3537 NO. LECANTO HIGHWAY, BEVERLY HILLS, FL 34465 | No data |
| REGISTERED AGENT NAME CHANGED | 2007-07-06 | RIVERA, HECTOR | No data |
| REINSTATEMENT | 2005-06-01 | No data | No data |
| REVOKED FOR ANNUAL REPORT | 2003-09-19 | No data | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J19000641827 | ACTIVE | 1000000841849 | POLK | 2019-09-23 | 2029-09-25 | $ 711.25 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, OUT OF STATE COLLECTIONS UNIT, 1415 W US HIGHWAY 90 STE 115, LAKE CITY FL320556156 |
| J18000716340 | ACTIVE | 1000000801067 | POLK | 2018-10-19 | 2028-10-24 | $ 340.56 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, OUT OF STATE COLLECTIONS UNIT, 1415 W US HIGHWAY 90 STE 115, LAKE CITY FL320556156 |
| J18000160382 | ACTIVE | 1000000779626 | POLK | 2018-04-13 | 2038-04-18 | $ 990.00 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, OUT OF STATE COLLECTIONS UNIT, 1415 W US HIGHWAY 90 STE 115, LAKE CITY FL320556156 |
| J18000160390 | ACTIVE | 1000000779627 | POLK | 2018-04-13 | 2028-04-18 | $ 573.74 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, OUT OF STATE COLLECTIONS UNIT, 1415 W US HIGHWAY 90 STE 115, LAKE CITY FL320556156 |
| J13000865312 | ACTIVE | 1000000494583 | LEON | 2013-04-25 | 2033-05-03 | $ 330.00 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, OUT OF STATE COLLECTIONS UNIT, 1401 W US HIGHWAY 90 STE 100, LAKE CITY FL320556123 |
| J13000865320 | LAPSED | 1000000494584 | CITRUS | 2013-04-19 | 2023-05-03 | $ 414.64 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, OUT OF STATE COLLECTIONS UNIT, 1401 W US HIGHWAY 90 STE 100, LAKE CITY FL320556123 |
| J13000378241 | ACTIVE | 1000000408318 | LEON | 2013-02-06 | 2033-02-13 | $ 300.00 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, OUT OF STATE COLLECTIONS UNIT, 1401 W US HIGHWAY 90 STE 100, LAKE CITY FL320556123 |
| J04900001403 | LAPSED | 03-20435-COCE-49 | BROWARD COUNTY COURT | 2003-12-16 | 2009-01-22 | $3652.00 | ANGELICA CORPORATION, 989 BELLEVUE AVENUE, DAYTONA BEACH, FL 32114 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2010-06-16 |
| ANNUAL REPORT | 2009-05-28 |
| ANNUAL REPORT | 2009-03-20 |
| ANNUAL REPORT | 2008-02-21 |
| ANNUAL REPORT | 2007-07-06 |
| ANNUAL REPORT | 2006-01-30 |
| REINSTATEMENT | 2005-06-01 |
| Reg. Agent Change | 2002-11-20 |
| ANNUAL REPORT | 2002-11-05 |
| Foreign Profit | 2001-01-02 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
