| Entity Name: | PORTABLE MEDICAL DIAGNOSTICS, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 22 Jun 1989 (36 years ago) |
| Document Number: | K97703 |
| FEI/EIN Number | 650134197 |
| Address: | 3540 FOREST HILL BLVD., WEST PALM BEACH, FL, 33406, US |
| Mail Address: | 3540 FOREST HILL BLVD., WEST PALM BEACH, FL, 33406, US |
| ZIP code: | 33406 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| Type | Company Name | Company Number | State |
|---|---|---|---|
| Headquarter of | PORTABLE MEDICAL DIAGNOSTICS, INC., MISSISSIPPI | 724166 | MISSISSIPPI |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1891125936 | 2013-11-26 | 2024-04-04 | 3540 FOREST HILL BLVD STE 112, WEST PALM BEACH, FL, 334065878, US | 3540 FOREST HILL BLVD STE 112, WEST PALM BEACH, FL, 334065878, US | |||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||
| Phone | +1 561-964-3311 |
| Fax | 5619643199 |
Authorized person
| Name | MR. ANDREW ROSEBROUGH |
| Role | VP, CFO |
| Phone | 5619643311 |
Taxonomy
| Taxonomy Code | 293D00000X - Physiological Laboratory |
| License Number | HCC4152 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 335V00000X - Portable X-ray and/or Other Portable Diagnostic Imaging Supplier |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICARE PROVIDER NUMBER |
| Number | W9857 |
| State | FL |
| Issuer | MEDICAID |
| Number | 008374300 |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| PORTABLE MEDICAL DIAGNOSTICS 401(K) PLAN | 2023 | 650134197 | 2024-07-26 | PORTABLE MEDICAL DIAGNOSTICS | 40 | |||||||||||||||||||||||
|
||||||||||||||||||||||||||||
| Role | Plan administrator |
| Date | 2024-07-26 |
| Name of individual signing | ANDREW ROSEBROUGH |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2022-01-01 |
| Business code | 621510 |
| Sponsor’s telephone number | 5619643311 |
| Plan sponsor’s address | 3540 FOREST HILL BLVD., SUITE 112, WEST PALM BEACH, FL, 33406 |
Signature of
| Role | Plan administrator |
| Date | 2023-10-12 |
| Name of individual signing | ANDREW ROSEBROUGH |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| Andrew Rosebrough | Agent | 3540 FOREST HILL BLVD., WEST PALM BEACH, FL, 33406 |
| Name | Role | Address |
|---|---|---|
| ROSEBROUGH ANDREW | President | 3540 FOREST HILL BLVD., WEST PALM BEACH, FL, 33406 |
| Name | Role | Address |
|---|---|---|
| ROSEBROUGH ANDREW | Secretary | 3540 FOREST HILL BLVD., WEST PALM BEACH, FL, 33406 |
| Name | Role | Address |
|---|---|---|
| ROSEBROUGH ANDREW | Treasurer | 3540 FOREST HILL BLVD., WEST PALM BEACH, FL, 33406 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| AMENDMENT | 2019-08-19 | No data | No data |
| REINSTATEMENT | 2013-10-08 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2013-09-27 | No data | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J12000400344 | LAPSED | 11-CA-019949 | PALM BEACH CIR CT | 2012-04-13 | 2017-05-10 | $110,481.75 | AMERICAN RADIOLOGIST METWORK INC, P.O. BOX 970, SIMI VALLEY, CA 93062 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
