| Entity Name: | DOCTORS IMAGING GROUP, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 06 Jan 2000 (25 years ago) |
| Last Event: | LC NAME CHANGE |
| Event Date Filed: | 29 Mar 2006 (19 years ago) |
| Document Number: | L00000000194 |
| FEI/EIN Number | 593618240 |
| Address: | 6685 NW 9TH BLVD, GAINESVILLE, FL, 32605, US |
| Mail Address: | 6685 NW 9TH BLVD, GAINESVILLE, FL, 32605, US |
| ZIP code: | 32605 |
| County: | Alachua |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1134179989 | 2006-05-11 | 2024-07-12 | 6716 NW 11TH PLACE, STE 200, GAINESVILLE, FL, 326054215, US | 6716 NW 11TH PL STE 200, GAINESVILLE, FL, 326054201, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 352-331-9729 |
| Fax | 3523310136 |
Authorized person
| Name | DR. DAN E WARE |
| Role | PRESIDENT |
| Phone | 3523319729 |
Taxonomy
| Taxonomy Code | 2085B0100X - Body Imaging Physician |
| Is Primary | No |
| Taxonomy Code | 2085N0700X - Neuroradiology Physician |
| Is Primary | No |
| Taxonomy Code | 2085N0904X - Nuclear Radiology Physician |
| Is Primary | No |
| Taxonomy Code | 2085R0202X - Diagnostic Radiology Physician |
| Is Primary | Yes |
| Taxonomy Code | 2085R0204X - Vascular & Interventional Radiology Physician |
| Is Primary | No |
| Taxonomy Code | 2085U0001X - Diagnostic Ultrasound Physician |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 259303305 |
| State | FL |
| Issuer | MEDICAID |
| Number | 259303300 |
| State | FL |
| Issuer | MEDICAID |
| Number | 259303304 |
| State | FL |
| Issuer | BCBSFL |
| Number | V2766 |
| State | FL |
| Issuer | MEDICAID |
| Number | 259303301 |
| State | FL |
| Issuer | AVMED |
| Number | 270855 |
| State | FL |
| Issuer | RRMCARE |
| Number | CK3155 |
| State | FL |
| Issuer | MEDICAID |
| Number | 259303303 |
| State | FL |
| Issuer | FL BCBS |
| Number | 45280 |
| State | FL |
| Issuer | MEDICAID |
| Number | 259303306 |
| State | FL |
| Issuer | BCBSFL |
| Number | 45280 |
| State | FL |
| Issuer | MEDICAID |
| Number | 017050900 |
| State | FL |
| Issuer | RAILROAD MEDICARE |
| Number | CK3155 |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DOCTORS IMAGING GROUP, LLC 401(K) PROFIT SHARING PLAN | 2022 | 593618240 | 2023-09-15 | DOCTORS IMAGING GROUP, LLC | 112 | |||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2023-09-15 |
| Name of individual signing | ADAM MEANS |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| KIM JONG H | Agent | 6685 NW 9TH BLVD, GAINESVILLE, FL, 32605 |
| Name | Role | Address |
|---|---|---|
| KIM JONG H | Auth | 6685 NW 9TH BLVD, GAINESVILLE, FL, 32605 |
| WILLIAMS WILLIE F | Auth | 6685 NW 9TH BLVD, GAINESVILLE, FL, 32605 |
| ACOSTA ANDRES R | Auth | 6685 NW 9TH BLVD, GAINESVILLE, FL, 32605 |
| Name | Role | Address |
|---|---|---|
| WARE DAN E | Authorized Person | 6685 NW 9TH BLVD, GAINESVILLE, FL, 32605 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G13000088896 | PUTNAM RADIOLOGY GROUP | ACTIVE | 2013-09-09 | 2028-12-31 | No data | 6685 NW 9TH BLVD, GAINESVILLE, FL, 32605 |
| G13000088897 | PUTNAM RADIOLOGY GROUP AND WOMEN'S CENTER | ACTIVE | 2013-08-09 | 2028-12-31 | No data | 6685 NW 9TH BLVD., GAINESVILLE, FL, 32605 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2025-01-28 | HARDIN, ROBERT L | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2016-03-25 | 6685 NW 9TH BLVD, GAINESVILLE, FL 32605 | No data |
| CHANGE OF MAILING ADDRESS | 2016-03-25 | 6685 NW 9TH BLVD, GAINESVILLE, FL 32605 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2016-03-25 | 6685 NW 9TH BLVD, GAINESVILLE, FL 32605 | No data |
| LC NAME CHANGE | 2006-03-29 | DOCTORS IMAGING GROUP, LLC | No data |
| LC NAME CHANGE | 2006-03-14 | GAINESVILLE RADIOLOGY GROUP WEST, LLC | No data |
| LC NAME CHANGE | 2006-03-03 | DOCTORS IMAGING GROUP, LLC | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J09000048792 | TERMINATED | 007082561 | 3697 001299 | 2008-10-22 | 2029-01-22 | $ 20.00 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, ALACHUA SERVICE CENTER, 14107 US HIGHWAY 441 STE 100, ALACHUA FL326156390 |
| J09000288752 | TERMINATED | 007082561 | 3697 001299 | 2008-10-22 | 2029-01-28 | $ 20.00 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, ALACHUA SERVICE CENTER, 14107 US HIGHWAY 441 STE 100, ALACHUA FL326156390 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-28 |
| ANNUAL REPORT | 2024-01-31 |
| ANNUAL REPORT | 2023-03-13 |
| ANNUAL REPORT | 2022-03-10 |
| ANNUAL REPORT | 2021-03-19 |
| ANNUAL REPORT | 2020-03-03 |
| ANNUAL REPORT | 2019-04-02 |
| ANNUAL REPORT | 2018-03-30 |
| ANNUAL REPORT | 2017-03-21 |
| ANNUAL REPORT | 2016-03-25 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
