| Entity Name: | LEWIS & KLANCKE CARDIOLOGY, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Domestic Profit
LEWIS & KLANCKE CARDIOLOGY, P.A. is structured as a Domestic Profit Corporation, which, in Florida signifies a Profit Corporation (also known as a C-Corporation). This business structure is recognized as a separate legal entity from its owners. This offers shareholders the benefit of limited liability protection, safeguarding their personal assets from the corporation's debts and obligations, and facilitates raising capital through the issuance of stock. In Florida, Domestic Profit Corporations are governed by Title XXXVI, Chapter 607, Florida Statutes – Florida Business Corporation Act. |
| Status: |
Active
The business entity is active. This status indicates that the business is currently operating and compliant with state regulations, suggesting a lower risk profile for lenders and potentially better creditworthiness. |
| Date Filed: | 01 Mar 1984 (41 years ago) |
| Last Event: | AMENDED AND RESTATED ARTICLES |
| Event Date Filed: | 18 Dec 2014 (10 years ago) |
| Document Number: | G88342 |
| FEI/EIN Number |
592385440
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 695 NORTH CLYDE MORRIS BLVD, DAYTONA BEACH, FL, 32114 |
| Mail Address: | 695 NORTH CLYDE MORRIS BLVD, DAYTONA BEACH, FL, 32114 |
| ZIP code: | 32114 |
| County: | Volusia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1376264788 | 2022-09-06 | 2023-10-03 | 695 N CLYDE MORRIS BLVD, DAYTONA BEACH, FL, 321142321, US | 3400 HALIFAX CROSSING BLVD STE 220, DELTONA, FL, 327252914, US | |||||||||||||||||||||||||||||||||||||||
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| Phone | +1 386-258-8722 |
| Fax | 3862589443 |
| Phone | +1 386-774-5485 |
| Fax | 3867750761 |
Authorized person
| Name | KATHLEEN T PHILLIPS |
| Role | CREDENTIALING COORDINATOR |
| Phone | 3862588722 |
Taxonomy
| Taxonomy Code | 207RC0000X - Cardiovascular Disease Physician |
| Is Primary | Yes |
| Taxonomy Code | 207RI0011X - Interventional Cardiology Physician |
| Is Primary | No |
| Taxonomy Code | 207UN0901X - Nuclear Cardiology Physician |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICARE |
| Number | 99279 |
| State | FL |
| Issuer | MEDICAID |
| Number | 119006900 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| RAYOS GLENN HDr. | Director | 695 NORTH CLYDE MORRIS BLVD, DAYTONA BEACH, FL, 32114 |
| WILSON VANCE E | Director | 695 N CLYDE MORRIS BLVD, DAYTONA BEACH, FL |
| WEST OSCAR Dr. | Director | 695 N. CLYDE MORRIS BLVD, DAYTONA BEACH, FL, 32114 |
| BROOME-WEBSTER CHAD LDr. | Director | 695 N CLYDE MORRIS BLVD, DAYTONA BEACH, FL, 32114 |
| SEIDE HANSCY Dr. | Director | 695 NORTH CLYDE MORRIS BLVD, DAYTONA BEACH, FL, 32114 |
| Bartholomew Beth HDr. | Director | 695 NORTH CLYDE MORRIS BLVD, DAYTONA BEACH, FL, 32114 |
| Rayos Glenn HMD | Agent | 695 N CLYDE MORRIS BLVD, DAYTONA BEACH, FL, 32114 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G24000086621 | DAYTONA HEART GROUP | ACTIVE | 2024-07-19 | 2029-12-31 | - | 695 N. CLYDE MORRIS BLVD., DAYTONA BEACH, FL, 32114 |
| G08168900375 | DAYTONA HEART GROUP | EXPIRED | 2008-06-16 | 2013-12-31 | - | 695 N CLYDE MORRIS BLVD, DAYTONA BEACH, FL, 32114 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2017-01-13 | Rayos, Glenn H, MD | - |
| AMENDED AND RESTATEDARTICLES | 2014-12-18 | - | - |
| REGISTERED AGENT ADDRESS CHANGED | 2000-04-21 | 695 N CLYDE MORRIS BLVD, DAYTONA BEACH, FL 32114 | - |
| NAME CHANGE AMENDMENT | 1992-04-27 | LEWIS & KLANCKE CARDIOLOGY, P.A. | - |
| CHANGE OF PRINCIPAL ADDRESS | 1990-06-15 | 695 NORTH CLYDE MORRIS BLVD, DAYTONA BEACH, FL 32114 | - |
| CHANGE OF MAILING ADDRESS | 1990-06-15 | 695 NORTH CLYDE MORRIS BLVD, DAYTONA BEACH, FL 32114 | - |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-31 |
| ANNUAL REPORT | 2023-01-19 |
| ANNUAL REPORT | 2022-02-01 |
| ANNUAL REPORT | 2021-01-25 |
| ANNUAL REPORT | 2020-01-27 |
| ANNUAL REPORT | 2019-01-15 |
| ANNUAL REPORT | 2018-01-11 |
| ANNUAL REPORT | 2017-01-13 |
| ANNUAL REPORT | 2016-01-25 |
| ANNUAL REPORT | 2015-02-23 |
Date of last update: 01 Mar 2025
Sources: Florida Department of State
