| Entity Name: | EXCEL DIAGNOSTIC SERVICES, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 26 Jan 2004 (21 years ago) |
| Date of dissolution: | 20 Aug 2012 (13 years ago) |
| Last Event: | LC VOLUNTARY DISSOLUTION |
| Event Date Filed: | 20 Aug 2012 (13 years ago) |
| Document Number: | L04000009949 |
| FEI/EIN Number | 800096450 |
| Address: | 1109 DARLINGTON OAK DR. N.E., ST. PETERSBURG, FL, 33703 |
| Mail Address: | 1109 DARLINGTON OAK DR. N.E., ST. PETERSBURG, FL, 33703 |
| ZIP code: | 33703 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1194729665 | 2005-06-12 | 2007-09-18 | 1109 DARLINGTON OAK DR NE, ST PETERSBURG, FL, 337036314, US | 1109 DARLINGTON OAK DR NE, ST PETERSBURG, FL, 337036314, US | |||||||||||||||||||||||||||||||
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| Phone | +1 727-521-0129 |
| Fax | 7275210130 |
Authorized person
| Name | MR. PREM D JAGERNAUTH |
| Role | MANAGER |
| Phone | 7275210129 |
Taxonomy
| Taxonomy Code | 293D00000X - Physiological Laboratory |
| License Number | HCC5616 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | AETNA |
| Number | 3580285 |
| State | FL |
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | V2896 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| JAGERNAUTH PREM DANNY | Agent | 1109 DARLINGTON OAK DR. N.E., ST. PETERSBURG, FL, 33703 |
| Name | Role | Address |
|---|---|---|
| JAGERNAUTH PREM D | Manager | 1109 DARLINGTON OAK DR NE, ST PETERSBURG, FL, 33703 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC VOLUNTARY DISSOLUTION | 2012-08-20 | No data | No data |
| Name | Date |
|---|---|
| LC Voluntary Dissolution | 2012-08-20 |
| ANNUAL REPORT | 2012-01-15 |
| ANNUAL REPORT | 2011-01-09 |
| ANNUAL REPORT | 2010-01-07 |
| ANNUAL REPORT | 2009-03-01 |
| ANNUAL REPORT | 2008-03-02 |
| ANNUAL REPORT | 2007-01-07 |
| ANNUAL REPORT | 2006-01-07 |
| ANNUAL REPORT | 2005-01-16 |
| Florida Limited Liabilites | 2004-01-26 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
