| Entity Name: | FLORIDA EAST COAST IMAGING, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 08 Nov 2005 (19 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: | L05000108668 |
| FEI/EIN Number | 203992257 |
| Address: | 951 N. WASHINGTON AVENUE, TITUSVILLE, FL, 32796 |
| Mail Address: | 951 N. WASHINGTON AVENUE, TITUSVILLE, FL, 32796 |
| ZIP code: | 32796 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1629194923 | 2007-03-21 | 2008-05-21 | PO BOX 15659, CLEARWATER, FL, 337665659, US | 5005 PORT ST JOHN PKWY, PORT ST JOHN, FL, 329274305, US | |||||||||||||||||||||||||||
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| Phone | +1 727-793-9300 |
| Phone | +1 321-636-9393 |
Authorized person
| Name | JOSEPH FLYNN |
| Role | PRESIDENT |
| Phone | 7277939300 |
Taxonomy
| Taxonomy Code | 2085R0202X - Diagnostic Radiology Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 278373800 |
| State | FL |
| Issuer | RR MCR |
| Number | DH0129 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BOYLES WILLIAM A | Agent | 301 EAST PINE STREET, SUITE 1400, ORLANDO, FL, 32801 |
| Name | Role |
|---|---|
| SPACE COAST IMAGING VENTURES, LLC | Manager |
| Name | Role | Address |
|---|---|---|
| N. BREVARD MEDICAL SUPPORT INC | Managing Member | 951 N. WASHINGTON AVENUE, TITUSVILLE, FL, 32796 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2012-09-28 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2011-01-26 |
| ANNUAL REPORT | 2010-01-22 |
| ANNUAL REPORT | 2009-04-07 |
| ANNUAL REPORT | 2008-06-12 |
| ANNUAL REPORT | 2007-03-09 |
| ANNUAL REPORT | 2006-06-08 |
| Florida Limited Liabilites | 2005-11-08 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
