| Entity Name: | PARK AVENUE HEART AND VASCULAR CENTER, L.L.C. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Inactive |
| Date Filed: | 17 Jun 2005 (20 years ago) |
| Date of dissolution: | 28 Sep 2012 (12 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 28 Sep 2012 (12 years ago) |
| Document Number: | L05000062890 |
| FEI/EIN Number | 20-3071260 |
| Address: | 2300 PARK AVE., SUITE 101-C, ORANGE PARK, FL 32073 |
| Mail Address: | C/O LAURIE TEPPERT, 2 SHIRCLIFF WAY STE 600, JACKSONVILLE, FL 32204 |
| ZIP code: | 32073 |
| County: | Clay |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1508818592 | 2006-05-17 | 2008-08-06 | 562 PARK ST, SUITE 310, JACKSONVILLE, FL, 322042918, US | 1824 KING ST, SUITE 250, JACKSONVILLE, FL, 322044735, US | |||||||||||||||||||
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| Phone | +1 904-633-2021 |
| Fax | 9046339793 |
| Phone | +1 904-388-1820 |
| Fax | 9043881827 |
Authorized person
| Name | MRS. CONNIE SUE CRAWFORD |
| Role | CREDENTIALING MANAGER |
| Phone | 9046332021 |
Taxonomy
| Taxonomy Code | 207RC0000X - Cardiovascular Disease Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| TEPPERT, LAURIE | Agent | 2 SHIRCLIFF WAY STE 600, JACKSONVILLE, FL 32204 |
| Name | Role | Address |
|---|---|---|
| PILCHER, GEORGE SMD | Officer | 1 SHIRCLIFF WAY, JACKSONVILLE, FL 32204 |
| Name | Role | Address |
|---|---|---|
| DARNELL, KAREN | Director | 1 SHIRCLIFF WAY, JACKSONVILLE, FL 32204 |
| MIKULIC, MARIANO BMD | Director | 1 SHIRCLIFF WAY, JACKSONVILLE, FL 32204 |
| GARAS, SAMER MMD | Director | 1 SHIRCLIFF WAY, JACKSONVILLE, FL 32204 |
| LEFEVER, SONYA LMD | Director | 1 SHIRCLIFF WAY, JACKSONVILLE, FL 32204 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G09107900068 | DCA CARDIAC CATH LAB | ACTIVE | 2029-04-17 | 2034-12-31 | No data | 1824 KING STREET, JACKSONVILLE, FL, 32204 |
| G09107900078 | DIAGNOSTIC CARDIOLOGY ASSOCIATES CARDIAC CATHETERIZATION LABORATORY | EXPIRED | 2009-04-17 | 2014-12-31 | No data | 1824 KING STREET, JACKSONVILLE, FL, 32204 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2012-09-28 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2009-04-27 | 2300 PARK AVE., SUITE 101-C, ORANGE PARK, FL 32073 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2008-03-26 | 2 SHIRCLIFF WAY STE 600, JACKSONVILLE, FL 32204 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2011-03-01 |
| ANNUAL REPORT | 2010-04-09 |
| ANNUAL REPORT | 2009-04-27 |
| ANNUAL REPORT | 2008-03-26 |
| ANNUAL REPORT | 2007-04-26 |
| ANNUAL REPORT | 2006-05-08 |
| Florida Limited Liabilites | 2005-06-17 |
Date of last update: 04 Jan 2025
Sources: Florida Department of State
