| Entity Name: | OPEN MRI OF OKEECHOBEE, L.L.C. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 02 Jun 2000 (25 years ago) |
| Document Number: | L00000006401 |
| FEI/EIN Number | 651012990 |
| Address: | 1615 NW Federal Highway, Stuart, FL, 34994, US |
| Mail Address: | 1615 NW FEDERAL HIGHWAY, STUART, FL, 34994, US |
| ZIP code: | 34994 |
| County: | Martin |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1093783292 | 2006-03-14 | 2008-03-19 | 115 NE 3RD ST, SUITE A, OKEECHOBEE, FL, 349722944, US | 115 NE 3RD ST, SUITE A, OKEECHOBEE, FL, 349722944, US | |||||||||||||||||||||
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| Phone | +1 863-824-6736 |
| Fax | 8638246737 |
Authorized person
| Name | MS. LINDA M MOODY |
| Role | INSURANCE BILLING SPECIALIST |
| Phone | 8638246736 |
Taxonomy
| Taxonomy Code | 2085R0202X - Diagnostic Radiology Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS FL |
| Number | V2486 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| WALKER ANDREW T | Agent | 1615 NW FEDERAL HWY, STUART, FL, 34972 |
| Name | Role | Address |
|---|---|---|
| WALKER ANDREW T | Managing Member | 1615 NW FEDERAL HWY, STUART, FL, 34994 |
| GALLANT ANDREW S | Managing Member | 1615 NW FEDERAL HWY, STUART, FL, 34994 |
| ZAYAS HENRY R | Managing Member | 1615 NW FEDERAL HWY, STUART, FL, 34994 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2018-09-28 | No data | No data |
Date of last update: 01 Jan 2025
Sources: Florida Department of State
