| Entity Name: | FLORIDA DIAGNOSTIC IMAGING, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 11 Jun 1984 (41 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 21 Aug 2019 (5 years ago) |
| Document Number: | H07598 |
| FEI/EIN Number | 59-2413179 |
| Address: | 5201 N.E. BABCOCK STREET, SUITE 5, PALM BAY, FL 32905 |
| Mail Address: | 5201 N.E. BABCOCK STREET, SUITE 5, PALM BAY, FL 32905 |
| ZIP code: | 32905 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| Type | Company Name | Company Number | State |
|---|---|---|---|
| Headquarter of | FLORIDA DIAGNOSTIC IMAGING, INC., IDAHO | 385056 | IDAHO |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1356305767 | 2006-04-13 | 2007-12-13 | 5201 BABCOCK ST NE, SUITE 5, PALM BAY, FL, 329054637, US | 5201 BABCOCK ST NE, SUITE 5, PALM BAY, FL, 329054637, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 321-676-5323 |
| Fax | 3219519253 |
Authorized person
| Name | DR. IAN LANDIS |
| Role | PRESIDENT |
| Phone | 3216765323 |
Taxonomy
| Taxonomy Code | 261QR0200X - Radiology Clinic/Center |
| License Number | HCC5282 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | AVMED |
| Number | 102370 |
| State | FL |
| Issuer | FLORIDIANCARE |
| Number | 40016 |
| State | FL |
| Issuer | EMBRACED PROGRAM |
| Number | FDA 155978 |
| State | FL |
| Issuer | BCBS OF FLORIDA |
| Number | V2489 |
| State | FL |
| Issuer | FIRST HEALTH/MAIL HANDLER |
| Number | 1209448 |
| State | FL |
| Issuer | UNITEDHEALTHCARE MEDIPASS |
| Number | 16-00554 |
| State | FL |
| Issuer | STAYWELL/WELLCARE |
| Number | 17030 |
| State | FL |
| Issuer | AMERIGROUP |
| Number | 288660 |
| State | FL |
| Issuer | UNITED HEALTHCARE |
| Number | 1488395 |
| State | FL |
| Issuer | HEALTHEASE |
| Number | 17030 |
| State | FL |
| Issuer | WORKERS COMPENSATION |
| Number | OS0004065 |
| State | FL |
| Issuer | CIGNA |
| Number | 0782103 |
| State | FL |
| Issuer | AETNA |
| Number | 8208068 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| J. PATRICK ANDERSON, ESQ. | Agent | 2200 FRONT STREET, 301, MELBOURNE, FL 32901 |
| Name | Role | Address |
|---|---|---|
| COTTI, BRUCE DAVID | Director | 1160 HOLLOW BROOK LANE, MALABAR, FL 32950 |
| LANDIS, IAN | Director | 4223 STRICKLAND WAY, VERO BEACH, FL 32967 |
| Name | Role | Address |
|---|---|---|
| COTTI, BRUCE DAVID | Vice President | 1160 HOLLOW BROOK LANE, MALABAR, FL 32950 |
| Name | Role | Address |
|---|---|---|
| COTTI, BRUCE DAVID | President | 1160 HOLLOW BROOK LANE, MALABAR, FL 32950 |
| LANDIS, IAN | President | 4223 STRICKLAND WAY, VERO BEACH, FL 32967 |
| Name | Role | Address |
|---|---|---|
| COTTI, BRUCE DAVID | Treasurer | 1160 HOLLOW BROOK LANE, MALABAR, FL 32950 |
| Name | Role | Address |
|---|---|---|
| LANDIS, IAN | Secretary | 4223 STRICKLAND WAY, VERO BEACH, FL 32967 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2020-05-20 | 2200 FRONT STREET, 301, MELBOURNE, FL 32901 | No data |
| AMENDMENT | 2019-08-21 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2012-02-07 | 5201 N.E. BABCOCK STREET, SUITE 5, PALM BAY, FL 32905 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2007-01-24 | 5201 N.E. BABCOCK STREET, SUITE 5, PALM BAY, FL 32905 | No data |
| REGISTERED AGENT NAME CHANGED | 2006-08-29 | J. PATRICK ANDERSON, ESQ. | No data |
| CANCEL ADM DISS/REV | 2005-09-23 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2005-09-16 | No data | No data |
| AMENDMENT | 1987-10-06 | No data | No data |
| AMENDMENT | 1987-03-23 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-05 |
| ANNUAL REPORT | 2023-01-16 |
| ANNUAL REPORT | 2022-01-27 |
| ANNUAL REPORT | 2021-01-13 |
| ANNUAL REPORT | 2020-05-20 |
| Amendment | 2019-08-21 |
| ANNUAL REPORT | 2019-02-11 |
| ANNUAL REPORT | 2018-01-11 |
| ANNUAL REPORT | 2017-01-11 |
| ANNUAL REPORT | 2016-01-25 |
Date of last update: 04 Feb 2025
Sources: Florida Department of State
