| Entity Name: | MEDERO MEDICAL OF LAKE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 16 Jan 2002 (23 years ago) |
| Date of dissolution: | 24 Dec 2009 (15 years ago) |
| Last Event: | LC VOLUNTARY DISSOLUTION |
| Event Date Filed: | 24 Dec 2009 (15 years ago) |
| Document Number: | L02000001293 |
| FEI/EIN Number | 611427881 |
| Mail Address: | 1109 S.W. 10TH STREET, OCALA, FL, 34471 |
| Address: | 312 SOUTH LAKE STREET, LEESBURG, FL, 34748 |
| ZIP code: | 34748 |
| County: | Lake |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1881831238 | 2009-01-07 | 2009-01-07 | 312 S LAKE ST, LEESBURG, FL, 347485934, US | 1109 SW 10TH ST, OCALA, FL, 344710325, US | |||||||||||||||||||
|
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| Phone | +1 352-629-3433 |
| Fax | 3526296796 |
Authorized person
| Name | MR. LARRY MAYFIELD |
| Role | ADMINISTRATOR |
| Phone | 3526293433 |
Taxonomy
| Taxonomy Code | 2083X0100X - Occupational Medicine Physician |
| License Number | 12664 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| DOMINIE COOKIE | Agent | 1109 SW 10TH STREET, OCALA, FL, 34471 |
| Name | Role | Address |
|---|---|---|
| DOMINIE MADELINE | Manager | 1109 SW 10TH STREET, OCALA, FL, 34471 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC VOLUNTARY DISSOLUTION | 2009-12-24 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2008-04-01 | 312 SOUTH LAKE STREET, LEESBURG, FL 34748 | No data |
| REGISTERED AGENT NAME CHANGED | 2008-04-01 | DOMINIE, COOKIE | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2008-04-01 | 1109 SW 10TH STREET, OCALA, FL 34471 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2003-11-20 | 312 SOUTH LAKE STREET, LEESBURG, FL 34748 | No data |
| CANCEL ADM DISS/REV | 2003-11-20 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2003-09-26 | No data | No data |
| Name | Date |
|---|---|
| LC Voluntary Dissolution | 2009-12-24 |
| ANNUAL REPORT | 2009-04-29 |
| ANNUAL REPORT | 2009-04-16 |
| ANNUAL REPORT | 2008-04-01 |
| ANNUAL REPORT | 2007-05-01 |
| ANNUAL REPORT | 2006-06-19 |
| ANNUAL REPORT | 2005-08-22 |
| ANNUAL REPORT | 2004-04-26 |
| REINSTATEMENT | 2003-11-20 |
| Florida Limited Liabilites | 2002-01-16 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
