| Entity Name: | FORT WALTON DIAGNOSTIC IMAGING CENTER, L.L.C. |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Florida Limited Liability Co.
FORT WALTON DIAGNOSTIC IMAGING CENTER, L.L.C. is structured as a Limited Liability Company (LLC), a common business structure that offers its members limited liability protection, separating their personal assets from the company's debts and obligations. |
| Status: |
Inactive
The business entity is inactive. This status may signal operational issues or voluntary closure, raising concerns about the business's ability to repay loans and requiring careful risk assessment by lenders. |
| Date Filed: | 02 Feb 2001 (24 years ago) |
| Date of dissolution: | 24 Sep 2010 (15 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 24 Sep 2010 (15 years ago) |
| Document Number: | L01000001819 |
| FEI/EIN Number |
651074896
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 1112 HOSPITAL RD, STE C, FORT WALTON BEACH, FL, 32547 |
| Mail Address: | 1112 HOSPITAL RD, STE C, FORT WALTON BEACH, FL, 32547 |
| ZIP code: | 32547 |
| County: | Okaloosa |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1619920642 | 2006-05-19 | 2020-08-22 | 1112 HOSPITAL RD, SUITE C, FORT WALTON BEACH, FL, 325476742, US | 1112 HOSPITAL RD, SUITE C, FORT WALTON BEACH, FL, 325476742, US | |||||||||||||||||||||||||||||||||||||||
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| Phone | +1 850-862-7070 |
| Fax | 8508620900 |
Authorized person
| Name | GARY MCMICHAEL |
| Role | MEMBER |
| Phone | 8508627070 |
Taxonomy
| Taxonomy Code | 261QM1300X - Multi-Specialty Clinic/Center |
| License Number | HCC4489 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 261QR0200X - Radiology Clinic/Center |
| License Number | HCC4489 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | BCBS FL PROVIDER NO. |
| Number | V2837 |
| State | FL |
| Issuer | AETNA PROVIDER NO. |
| Number | 7732283 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MCMICHAEL GARY W | Managing Member | 323 PAGE BACON RD #17, MARY ESTHER, FL, 32569 |
| ZACHOS KALLIOPE | Managing Member | 4154 BEACH DR, NICEVILLE, FL, 32578 |
| MCMICHAEL GARY | Agent | 1112 HOSPITAL RD, FORT WALTON BEACH, FL, 32547 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2010-09-24 | - | - |
| CHANGE OF PRINCIPAL ADDRESS | 2008-05-01 | 1112 HOSPITAL RD, STE C, FORT WALTON BEACH, FL 32547 | - |
| CHANGE OF MAILING ADDRESS | 2008-05-01 | 1112 HOSPITAL RD, STE C, FORT WALTON BEACH, FL 32547 | - |
| REGISTERED AGENT NAME CHANGED | 2004-04-28 | MCMICHAEL, GARY | - |
| REGISTERED AGENT ADDRESS CHANGED | 2002-04-17 | 1112 HOSPITAL RD, SUITE C, FORT WALTON BEACH, FL 32547 | - |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2009-05-01 |
| ANNUAL REPORT | 2008-05-01 |
| ANNUAL REPORT | 2007-05-09 |
| ANNUAL REPORT | 2006-05-01 |
| ANNUAL REPORT | 2005-04-18 |
| ANNUAL REPORT | 2004-04-28 |
| ANNUAL REPORT | 2003-05-05 |
| ANNUAL REPORT | 2002-04-17 |
| Florida Limited Liabilites | 2001-02-02 |
Date of last update: 03 Apr 2025
Sources: Florida Department of State
