| Entity Name: | HNI MEDICAL SERVICES, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Not For Profit Corporation |
| Status: | Inactive |
| Date Filed: | 06 Jun 2011 (14 years ago) |
| Date of dissolution: | 29 Dec 2021 (3 years ago) |
| Last Event: | WITHDRAWAL |
| Event Date Filed: | 29 Dec 2021 (3 years ago) |
| Document Number: | F11000002369 |
| FEI/EIN Number | 80-0725733 |
| Mail Address: | 7500 RIALTO BLVD., BLDG. 1, STE. 140, AUSTIN, TX 78735 |
| Address: | 7500 RIALTO BLVD. Building 1, Suite 140, AUSTIN, TX 78735 |
| Place of Formation: | TEXAS |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1174974703 | 2016-06-24 | 2019-07-16 | 7500 RIALTO BLVD STE 1-140, AUSTIN, TX, 787358534, US | 8971 DANIELS CENTER DR, SUITE 307, FORT MYERS, FL, 339120310, US | |||||||||||||||||||||||||||||||
|
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| Phone | +1 512-730-3060 |
| Fax | 8887301925 |
Authorized person
| Name | SCOTT KLOSTERMAN |
| Role | CFO |
| Phone | 5127303056 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 208M00000X - Hospitalist Physician |
| Is Primary | Yes |
| Taxonomy Code | 363A00000X - Physician Assistant |
| Is Primary | No |
| Taxonomy Code | 363L00000X - Nurse Practitioner |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| BLAKE, HUGO G | Director | 7500 RIALTO BLVD Building 1 Suite 140, AUSTIN, TX 78735 |
| Gomez, Adriana M.D. | Director | 7500 RIALTO BLVD. Building 1, Suite 140, AUSTIN, TX 78735 |
| TOVAR, REUBEN | Director | 7500 RIALTO BLVD. Building 1, Suite 140, AUSTIN, TX 78735 |
| Name | Role | Address |
|---|---|---|
| Gonzales, Michael | President | 7500 RIALTO BLVD. Building 1, Suite 140, AUSTIN, TX 78735 |
| Name | Role | Address |
|---|---|---|
| Gonzales, Michael | Chief Executive Officer | 7500 RIALTO BLVD. Building 1, Suite 140, AUSTIN, TX 78735 |
| Name | Role | Address |
|---|---|---|
| Ung , Oon Soo | Chief Financial Officer | 7500 RIALTO BLVD. Building 1, Suite 140, AUSTIN, TX 78735 |
| Name | Role | Address |
|---|---|---|
| Tovar, Reuben | Secretary | 7500 RIALTO BLVD. Building 1, Suite 140, AUSTIN, TX 78735 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| WITHDRAWAL | 2021-12-29 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2021-12-29 | 7500 RIALTO BLVD. Building 1, Suite 140, AUSTIN, TX 78735 | No data |
| REGISTERED AGENT CHANGED | 2021-12-29 | REGISTERED AGENT REVOKED | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2015-11-17 | 7500 RIALTO BLVD. Building 1, Suite 140, AUSTIN, TX 78735 | No data |
| Name | Date |
|---|---|
| WITHDRAWAL | 2021-12-29 |
| ANNUAL REPORT | 2021-07-26 |
| ANNUAL REPORT | 2020-06-08 |
| ANNUAL REPORT | 2019-02-11 |
| ANNUAL REPORT | 2018-05-01 |
| ANNUAL REPORT | 2017-04-10 |
| ANNUAL REPORT | 2016-05-02 |
| AMENDED ANNUAL REPORT | 2015-11-17 |
| ANNUAL REPORT | 2015-02-22 |
| ANNUAL REPORT | 2014-05-07 |
Date of last update: 24 Jan 2025
Sources: Florida Department of State
