| Entity Name: | CANTONMENT MEDICAL CENTER, L.L.C. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 25 Oct 2004 (20 years ago) |
| Date of dissolution: | 08 Feb 2010 (15 years ago) |
| Last Event: | LC VOLUNTARY DISSOLUTION |
| Event Date Filed: | 08 Feb 2010 (15 years ago) |
| Document Number: | L04000078323 |
| FEI/EIN Number | 810657750 |
| Address: | 748 HIGHWAY 29 N, CANTONMENT, FL, 32533 |
| Mail Address: | 748 HIGHWAY 29 N, CANTONMENT, FL, 32533 |
| ZIP code: | 32533 |
| County: | Escambia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1396727277 | 2005-11-16 | 2008-04-20 | 748 N HIGHWAY 29, CANTONMENT, FL, 325339513, US | 748 N HIGHWAY 29, CANTONMENT, FL, 325339513, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 850-937-4004 |
| Fax | 8509374006 |
Authorized person
| Name | DR. FADEL SALIB |
| Role | OWNER |
| Phone | 8509374004 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | ME87968 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 2084P0800X - Psychiatry Physician |
| License Number | ME70527 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS FL |
| Number | 44104 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SALIB FADEL A | Agent | 748 HIGHWAY 29 N, CANTONMENT, FL, 32533 |
| Name | Role | Address |
|---|---|---|
| SALIB FADEL A | Manager | 748 HIGHWAY 29 N, CANTONMENT, FL, 32533 |
| SALIB MARY Y | Manager | 748 HIGHWAY 29 N, CANTONMENT, FL, 32533 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC VOLUNTARY DISSOLUTION | 2010-02-08 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2006-01-11 | 748 HIGHWAY 29 N, CANTONMENT, FL 32533 | No data |
| CHANGE OF MAILING ADDRESS | 2006-01-11 | 748 HIGHWAY 29 N, CANTONMENT, FL 32533 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2006-01-11 | 748 HIGHWAY 29 N, CANTONMENT, FL 32533 | No data |
| Name | Date |
|---|---|
| LC Voluntary Dissolution | 2010-02-08 |
| ANNUAL REPORT | 2009-01-16 |
| ANNUAL REPORT | 2008-01-07 |
| ANNUAL REPORT | 2007-01-08 |
| ANNUAL REPORT | 2006-01-11 |
| ANNUAL REPORT | 2005-04-19 |
| Florida Limited Liabilites | 2004-10-25 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
