| Entity Name: | NORTH FLORIDA MEDICAL CORP. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 26 Apr 1989 (36 years ago) |
| Document Number: | K83803 |
| FEI/EIN Number | 592946071 |
| Address: | 655 E MAIN STREET, LAKE BUTLER, FL, 32054 |
| Mail Address: | 655 E MAIN STREET, LAKE BUTLER, FL, 32054 |
| ZIP code: | 32054 |
| County: | Union |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1790839678 | 2007-01-22 | 2012-05-24 | 655 E MAIN ST, LAKE BUTLER, FL, 320541352, US | 655 E MAIN ST, LAKE BUTLER, FL, 320541352, US | |||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 386-496-3656 |
Authorized person
| Name | SALVADOR ANTONIO PEREZ |
| Role | PRESIDENT |
| Phone | 3864961575 |
Taxonomy
| Taxonomy Code | 332B00000X - Durable Medical Equipment & Medical Supplies |
| License Number | 576 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 332BX2000X - Oxygen Equipment & Supplies (DME) |
| License Number | 32011614 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | M1087 |
| State | FL |
| Issuer | MEDICAID |
| Number | 027755000 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| PEREZ SALVADOR A | Agent | 270 NE 8TH AVE., LAKE BUTLER, FL, 32054 |
| Name | Role | Address |
|---|---|---|
| PEREZ SALVADOR A | President | 270 N.E. 8TH AVE., LAKE BUTLER, FL, 32054 |
| Name | Role | Address |
|---|---|---|
| PEREZ SALVADOR A | Director | 270 N.E. 8TH AVE., LAKE BUTLER, FL, 32054 |
| PEREZ GRACE P | Director | 270 NE 8TH AVENUE, LAKE BUTLER, FL, 32054 |
| Name | Role | Address |
|---|---|---|
| PEREZ GRACE P | Secretary | 270 NE 8TH AVENUE, LAKE BUTLER, FL, 32054 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G12000050856 | UNION MEDICAL SUPPLY | ACTIVE | 2012-06-04 | 2027-12-31 | No data | 655 E. MAIN STREET, LAKE BUTLER, FL, 32054 |
Date of last update: 02 Jan 2025
Sources: Florida Department of State
