| Entity Name: | JOHNSON MEDICAL CENTER OF VENICE, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 21 May 1986 (39 years ago) |
| Document Number: | J15431 |
| FEI/EIN Number | 592677819 |
| Address: | 401 JOHNSON LANE, #101, VENICE, FL, 34285 |
| Mail Address: | 401 JOHNSON LANE, #101, VENICE, FL, 34285 |
| ZIP code: | 34285 |
| County: | Sarasota |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1578622981 | 2006-12-08 | 2021-03-17 | 401 JOHNSON LN, SUITE 101, VENICE, FL, 342856280, US | 401 JOHNSON LN, SUITE 101, VENICE, FL, 342856280, US | |||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 941-484-5333 |
| Fax | 9414882834 |
Authorized person
| Name | JEFFREY P. JOHNSON |
| Role | OWNER/PROVIDER |
| Phone | 9414845333 |
Taxonomy
| Taxonomy Code | 111N00000X - Chiropractor |
| License Number | CH5308 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 111N00000X - Chiropractor |
| License Number | CH 8175 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | ME90236 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 363LA2200X - Adult Health Nurse Practitioner |
| Is Primary | No |
Other Provider Identifiers
| Issuer | NPI |
| Number | 1144549163 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| JOHNSON, JEFFREY P. | Agent | 230 S TAMIAMI TR, VENICE, FL, 34285 |
| Name | Role | Address |
|---|---|---|
| JOHNSON JEFFREY P | Director | 230 S TAMIAMI TRAIL, VENICE, FL |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G22000117100 | ENICE PREMIER KNEE, BACK, AND JOINT PAIN CLINIC | ACTIVE | 2022-09-16 | 2027-12-31 | No data | 401 JOHNSON LANE, #101, VENICE, FL, 32485 |
| G22000117109 | SARASOTA PREMIER KNEE, BACK, AND JOINT PAIN CLINIC | ACTIVE | 2022-09-16 | 2027-12-31 | No data | 401 JOHNSON LANE, #101, VENICE, FL, 32485 |
| G22000117117 | VENICE PREMIER CHOICE KNEE, BACK, AND JOINT PAIN CLINIC | ACTIVE | 2022-09-16 | 2027-12-31 | No data | 401 JOHNSON LANE, #101, SUITE 101, VENICE, FL, 34285 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| NAME CHANGE AMENDMENT | 2001-08-29 | JOHNSON MEDICAL CENTER OF VENICE, INC. | No data |
| AMENDMENT AND NAME CHANGE | 1998-03-09 | JOHNSON CHIROPRACTIC CLINIC, P.A. | No data |
Date of last update: 01 Jan 2025
Sources: Florida Department of State
