| Entity Name: | PHYSICIANS INJURY MEDICAL CENTER, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 02 Feb 2004 (21 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 05 Nov 2014 (10 years ago) |
| Document Number: | L04000008891 |
| FEI/EIN Number | 200730823 |
| Address: | 8546 WEST HOMOSASSA TRAIL, SUITE 7, HOMOSASSA SPRINGS, FL, 34448, US |
| Mail Address: | PO BOX 190, HOMOSASSA, FL, 34447, US |
| ZIP code: | 34448 |
| County: | Citrus |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1275600835 | 2006-11-29 | 2020-08-22 | 4770 US HIGHWAY 19, NEW PORT RICHEY, FL, 346524944, US | 4770 US HIGHWAY 19, NEW PORT RICHEY, FL, 346524944, US | |||||||||||||||||||||||||||||||||||||
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| Phone | +1 727-841-9998 |
| Fax | 7278419848 |
Authorized person
| Name | DR. JOSE E GRAU JR. |
| Role | PRESIDENT |
| Phone | 7278419998 |
Taxonomy
| Taxonomy Code | 111N00000X - Chiropractor |
| License Number | CH3514 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 111N00000X - Chiropractor |
| License Number | CH7939 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 174400000X - Specialist |
| Is Primary | No |
Other Provider Identifiers
| Issuer | BLUE CROSS & BLUE SHIELD |
| Number | 34705 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| THOMAS RICHARD D.C. | Agent | 8546 WEST HOMOSASSA TRAIL, SUITE 7, HOMOSASSA SPRINGS, FL, 34448 |
| Name | Role | Address |
|---|---|---|
| THOMAS RICHARD DC | Managing Member | PO BOX 190, HOMOSASSA, FL, 34447 |
| Name | Role | Address |
|---|---|---|
| GRAU JOSE EJR MD | Manager | PO BOX 190, HOMOSASSA, FL, 34447 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2022-04-02 | 8546 WEST HOMOSASSA TRAIL, SUITE 7, HOMOSASSA SPRINGS, FL 34448 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2015-04-03 | 8546 WEST HOMOSASSA TRAIL, SUITE 7, HOMOSASSA SPRINGS, FL 34448 | No data |
| CHANGE OF MAILING ADDRESS | 2015-04-03 | 8546 WEST HOMOSASSA TRAIL, SUITE 7, HOMOSASSA SPRINGS, FL 34448 | No data |
| LC AMENDMENT | 2014-11-05 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2013-10-21 | THOMAS, RICHARD, D.C. | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J07900009923 | LAPSED | 05-5240-CI-11 | PINELLAS CTY FL 6TH JUD CIR | 2007-04-20 | 2012-07-02 | $58829.02 | KINCAID FAMILY LIMITED PARTNERSHIP, 714 SANDY POINTE LANE, ROUND LAKE PARK, IL 60073 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-30 |
| ANNUAL REPORT | 2023-04-05 |
| ANNUAL REPORT | 2022-04-02 |
| ANNUAL REPORT | 2021-04-06 |
| ANNUAL REPORT | 2020-06-18 |
| ANNUAL REPORT | 2019-04-11 |
| ANNUAL REPORT | 2018-03-18 |
| ANNUAL REPORT | 2017-03-27 |
| ANNUAL REPORT | 2016-03-28 |
| ANNUAL REPORT | 2015-04-03 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
