| Entity Name: | PHOENIX MEDICAL LABORATORY, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 02 Mar 2004 (21 years ago) |
| Date of dissolution: | 25 Sep 2009 (15 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 25 Sep 2009 (15 years ago) |
| Document Number: | L04000016454 |
| FEI/EIN Number | 331086435 |
| Address: | 11220 METRO PARKWAY, UNIT 1, FT. MYERS, FL, 33966 |
| Mail Address: | 11220 METRO PARKWAY, UNIT 1, FT. MYERS, FL, 33966 |
| ZIP code: | 33966 |
| County: | Lee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1841280815 | 2005-10-21 | 2008-05-29 | 12701 COMMONWEALTH DR, SUITE 6, FORT MYERS, FL, 339138626, US | 12701 COMMONWEALTH DR, SUITE 6, FORT MYERS, FL, 339138626, US | |||||||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 239-768-0600 |
| Fax | 2397680711 |
Authorized person
| Name | MR. ROBERT P GASPARINI |
| Role | PRESIDENT |
| Phone | 2397680600 |
Taxonomy
| Taxonomy Code | 291U00000X - Clinical Medical Laboratory |
| License Number | CLIA10D1023653 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 291U00000X - Clinical Medical Laboratory |
| License Number | 8000017185 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 291U00000X - Clinical Medical Laboratory |
| License Number | 8000019289 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS FL |
| Number | L9266 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| FERNANDEZ RICHARD | Agent | 11220 METRO PARKWAY, UNIT 1, FT. MYERS, FL, 33966 |
| Name | Role | Address |
|---|---|---|
| FERNANDEZ RICHARD | Manager | 11220 METRO PARKWAY, UNIT 1, FT. MYERS, FL, 33966 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2009-09-25 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2006-07-19 | 11220 METRO PARKWAY, UNIT 1, FT. MYERS, FL 33966 | No data |
| CHANGE OF MAILING ADDRESS | 2006-07-19 | 11220 METRO PARKWAY, UNIT 1, FT. MYERS, FL 33966 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2006-07-19 | 11220 METRO PARKWAY, UNIT 1, FT. MYERS, FL 33966 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2008-04-30 |
| ANNUAL REPORT | 2007-01-04 |
| ANNUAL REPORT | 2006-07-19 |
| ANNUAL REPORT | 2005-04-19 |
| Florida Limited Liabilites | 2004-03-02 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
