| Entity Name: | CHIEFLAND MEDICAL CENTER, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 27 Jan 2004 (21 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 01 Nov 2019 (5 years ago) |
| Document Number: | L04000009502 |
| FEI/EIN Number | 510497038 |
| Address: | 1113 NW 23RD AVENUE, CHIEFLAND, FL, 32626 |
| Mail Address: | 5843 COLFAX AVENUE, ALEXANDRIA, VA, 22311 |
| ZIP code: | 32626 |
| County: | Levy |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1184674384 | 2006-05-11 | 2007-09-20 | 1113 NW 23RD AVE, CHIEFLAND, FL, 326261911, US | 1113 NW 23RD AVE, CHIEFLAND, FL, 326261911, US | |||||||||||||||||||||||||
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| Phone | +1 352-493-9500 |
| Fax | 3524937070 |
Authorized person
| Name | JOHN L CONNOLE II |
| Role | EXEC DIRECTOR |
| Phone | 3524939500 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | HCC4256 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS |
| Number | 21419 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MINTON MARIE S | Agent | 1113 NW 23RD AVENUE, CHIEFLAND, FL, 32626 |
| Name | Role | Address |
|---|---|---|
| MINTON MARIE S | Manager | 5843 COLFAX AVE, ALEX, VA, 22311 |
| Name | Role | Address |
|---|---|---|
| MINTON STEPHEN M | Auth | 5843 COLFAX AVENUE, ALEXANDRIA, VA, 22311 |
| WASHBURN GREGORY S | Auth | P.O. BOX 101853, ARLINGTON, VA, 22210 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2019-11-01 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2019-11-01 | MINTON, MARIE SMGRM | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2019-09-27 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2010-02-01 | 1113 NW 23RD AVENUE, CHIEFLAND, FL 32626 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2010-02-01 | 1113 NW 23RD AVENUE, C/O CHIEFLAND MEDICAL CENTER, LLC, CHIEFLAND, FL 32626 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-20 |
| ANNUAL REPORT | 2023-03-09 |
| ANNUAL REPORT | 2022-03-03 |
| ANNUAL REPORT | 2021-02-23 |
| ANNUAL REPORT | 2020-07-11 |
| REINSTATEMENT | 2019-11-01 |
| ANNUAL REPORT | 2018-03-01 |
| ANNUAL REPORT | 2017-04-21 |
| ANNUAL REPORT | 2016-02-11 |
| ANNUAL REPORT | 2015-03-18 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
