| Entity Name: | UNIVERSITY DIAGNOSTIC INSTITUTE WINTER PARK, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 20 Sep 2001 (23 years ago) |
| Document Number: | L01000016240 |
| FEI/EIN Number | 593746972 |
| Address: | 111 NORTH LAKEMONT AVENUE, SUITE 1A, WINTER PARK, FL, 32792 |
| Mail Address: | 111 NORTH LAKEMONT AVENUE, SUITE 1A, WINTER PARK, FL, 32792 |
| ZIP code: | 32792 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1417917253 | 2006-03-24 | 2019-09-19 | 111 N LAKEMONT AVE, WINTER PARK, FL, 327923213, US | 111 N LAKEMONT AVE, WINTER PARK, FL, 327923213, US | |||||||||||||||||||||
|
|||||||||||||||||||||||||
| Phone | +1 407-975-3315 |
| Fax | 4076910316 |
Authorized person
| Name | MR. MICHAEL LAMB |
| Role | CEO |
| Phone | 4079753315 |
Taxonomy
| Taxonomy Code | 261QR0200X - Radiology Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 263170900 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| STANLEY GEORGE A | Agent | C/O UDI WINTER PARK, WINTER PARK, FL, 32792 |
| Name | Role | Address |
|---|---|---|
| STANLEY GEORGE A | Managing Member | 111 NORTH LAKEMONT AVENUE, WINTER PARK, FL, 32792 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G22000096620 | UNIVERSITY DIAGNOSTIC INSTITUTE LAKE MARY | ACTIVE | 2022-08-16 | 2027-12-31 | No data | 111 N LAKEMONT AVE, STE 1A, WINTER PARK, FL, 32792 |
| G19000096357 | UNVERSITY DIAGNOSTIC INSTITUTE ORLANDO | EXPIRED | 2019-09-04 | 2024-12-31 | No data | 111 N.LAKEMONT AVE, WINTER PARK, FL, 32792 |
| G19000096358 | UNIVERSITY DIADNOSTIC IMAGING LONGWOOD | EXPIRED | 2019-09-04 | 2024-12-31 | No data | 111 N.LAKEMONT AVE, WINTER PARK, FL, 32792 |
| G19000096359 | UNIVERSITY DIAGNOSTIC IMSTITUTE LONGWOOD | EXPIRED | 2019-09-04 | 2024-12-31 | No data | 111 NORTH LAKEMONT AVENUE, WINTER PARK, FL, 32792 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2010-01-05 | STANLEY, GEORGE AMD | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2010-01-05 | C/O UDI WINTER PARK, 111 N. LAKEMONT AVE., WINTER PARK, FL 32792 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2008-07-07 | 111 NORTH LAKEMONT AVENUE, SUITE 1A, WINTER PARK, FL 32792 | No data |
| CHANGE OF MAILING ADDRESS | 2008-07-07 | 111 NORTH LAKEMONT AVENUE, SUITE 1A, WINTER PARK, FL 32792 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-26 |
| ANNUAL REPORT | 2023-03-17 |
| ANNUAL REPORT | 2022-04-07 |
| ANNUAL REPORT | 2021-02-02 |
| ANNUAL REPORT | 2020-02-19 |
| ANNUAL REPORT | 2019-02-25 |
| ANNUAL REPORT | 2018-02-22 |
| ANNUAL REPORT | 2017-03-03 |
| ANNUAL REPORT | 2016-01-27 |
| ANNUAL REPORT | 2015-01-19 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
