| Entity Name: | AXIOM MEDICAL CLINIC, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 07 Apr 2005 (20 years ago) |
| Date of dissolution: | 15 Sep 2006 (18 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 15 Sep 2006 (18 years ago) |
| Document Number: | L05000034062 |
| Address: | 9507 ANDERSON ROAD, TAMPA, FL, 33634 |
| Mail Address: | 9507 ANDERSON ROAD, TAMPA, FL, 33634 |
| ZIP code: | 33634 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1750335329 | 2006-05-19 | 2020-08-22 | 7177 CRIMSON RIDGE DR, SUITE 14, ROCKFORD, IL, 611076208, US | 9507 ANDERSON RD, TAMPA, FL, 336341252, US | |||||||||||||||||||||||||||||||||||||||
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| Phone | +1 815-227-9900 |
| Fax | 8152279805 |
| Phone | +1 813-319-1330 |
| Fax | 8133191340 |
Authorized person
| Name | WENDY NEWMAN |
| Role | COMPTROLLER |
| Phone | 8152279900 |
Taxonomy
| Taxonomy Code | 111N00000X - Chiropractor |
| License Number | CH 8788 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | ME 93347 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 225100000X - Physical Therapist |
| License Number | PT20245 |
| State | FL |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| MATHER KENNETH G | Agent | 100 SOUTH ASHLEY DRIVE, TAMPA, FL, 33602 |
| Name | Role |
|---|---|
| NTB, LTD. | Manager |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2006-09-15 | No data | No data |
| Name | Date |
|---|---|
| Florida Limited Liability | 2005-04-07 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
