| Entity Name: | NEW SMYRNA DIAGNOSTIC IMAGING, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 31 Dec 2002 (22 years ago) |
| Date of dissolution: | 14 Sep 2007 (17 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 14 Sep 2007 (17 years ago) |
| Document Number: | L02000035224 |
| FEI/EIN Number | 050548487 |
| Address: | 600 PALMETTO STREET, NEW SMYRNA BEACH, FL, 32168 |
| Mail Address: | C/O 350 NORTH CAUSEWAY, NEW SMYRNA BEACH, FL, 32169 |
| ZIP code: | 32168 |
| County: | Volusia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1609887603 | 2006-08-11 | 2020-08-22 | PO BOX 2240, DAYTONA BEACH, FL, 321152240, US | 401 PALMETTO ST, NEW SMYRNA BEACH, FL, 321687322, US | |||||||||||||||||||||
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| Phone | +1 386-255-9120 |
| Phone | +1 386-424-5140 |
Authorized person
| Name | MR. AL FALCO |
| Role | CHIEF OPERATING OFFICER |
| Phone | 3862747118 |
Taxonomy
| Taxonomy Code | 2085R0202X - Diagnostic Radiology Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS |
| Number | 98142 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| HEEKIN JIM | Agent | 215 NORTH EOLA DRIVE, ORLANDO, FL, 32801 |
| Name | Role | Address |
|---|---|---|
| BERT FISH MEDICAL CTR | Managing Member | 600 PALMETTO STREET, NEW SMYRNA BEACH, FL, 32168 |
| NEW SMYRNA RADIOLOGY ASSOCIATES | Managing Member | 401 PALMETTO ST, NEW SMYRNA BEACH, FL, 32168 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2007-09-14 | No data | No data |
| REINSTATEMENT | 2003-11-26 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2003-11-26 | 600 PALMETTO STREET, NEW SMYRNA BEACH, FL 32168 | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2003-09-26 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2006-01-23 |
| ANNUAL REPORT | 2005-02-21 |
| ANNUAL REPORT | 2004-02-03 |
| REINSTATEMENT | 2003-11-26 |
| Florida Limited Liabilites | 2002-12-31 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
