| Entity Name: | JACKSONVILLE MULTISPECIALTY GROUP, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 02 May 2006 (19 years ago) |
| Last Event: | LC STMNT OF RA/RO CHG |
| Event Date Filed: | 12 Nov 2021 (3 years ago) |
| Document Number: | L06000045780 |
| FEI/EIN Number | 204812029 |
| Address: | 3627 University Boulevard, South, Suite 61, JACKSONVILLE, FL, 32216, US |
| Mail Address: | P.O. BOX 17577, JACKSONVILLE, FL, 32245-7577, US |
| ZIP code: | 32216 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1609951938 | 2006-10-26 | 2023-12-01 | PO BOX 17577, JACKSONVILLE, FL, 322457577, US | 3627 UNIVERSITY BLVD S STE 615, JACKSONVILLE, FL, 322167401, US | |||||||||||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 904-399-1623 |
| Fax | 9043991624 |
Authorized person
| Name | DR. HERNAN ROBERT CHANG |
| Role | PRESIDENT |
| Phone | 9043991623 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 207RI0200X - Infectious Disease Physician |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 208M00000X - Hospitalist Physician |
| Is Primary | No |
| Taxonomy Code | 208VP0014X - Interventional Pain Medicine Physician |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 001151900 |
| State | FL |
| Name | Role |
|---|---|
| COGENCY GLOBAL INC. | Agent |
| Name | Role | Address |
|---|---|---|
| CHANG HERNAN R | Manager | P. O. BOX 17577, JACKSONVILLE, FL, 32245 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G14000051380 | CORPORATE RECRUITMENT SOLUTIONS | EXPIRED | 2014-05-27 | 2019-12-31 | No data | P. O. BOX 54369, JACKSONVILLE, FL, 32245 |
| G12000077675 | NORTH FLORIDA RHEUMATOLOGY | EXPIRED | 2012-08-06 | 2017-12-31 | No data | P. O. BOX 17577, JACKSONVILLE, FL, 32245 |
| G12000077686 | ENDOCRINOLOGY OF NORTH FLORIDA | EXPIRED | 2012-08-06 | 2017-12-31 | No data | P. O. BOX 17577, JACKSONVILLE, FL, 32245 |
| G12000049005 | JACKSONVILLE ONCOLOGY | EXPIRED | 2012-05-29 | 2017-12-31 | No data | P.O. BOX 17577, JACKSONVILLE, FL, 32245 |
| G12000048494 | JACKSONVILLE PAIN SPECIALISTS | EXPIRED | 2012-05-25 | 2017-12-31 | No data | P. O. BOX 17577, JACKSONVILLE, FL, 32245 |
| G12000024342 | JACKSONVILLE PRIMARY HEALTHCARE - MACCLENNY OFFICE | EXPIRED | 2012-03-09 | 2017-12-31 | No data | P. O. BOX 17577, JACKSONVILLE, FL, 32245 |
| G11000032623 | ACUTE CARE HOSPITALISTS | ACTIVE | 2011-04-01 | 2026-12-31 | No data | P. O. BOX 17577, JACKSONVILLE, FL, 32245 |
| G11000032621 | JACKSONVILLE INFECTIOUS DISEASES | ACTIVE | 2011-04-01 | 2026-12-31 | No data | P. O. BOX 17577, JACKSONVILLE, FL, 32245 |
| G11000032618 | JACKSONVILLE PRIMARY HEALTHCARE | EXPIRED | 2011-04-01 | 2016-12-31 | No data | P. O. BOX 17577, JACKSONVILLE, FL, 32245 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2022-02-03 | COGENCY GLOBAL INC. | No data |
| LC STMNT OF RA/RO CHG | 2021-11-12 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-11-12 | 115 NORTH CALHOUN ST, SUITE 4, TALLAHASSEE, FL 32301 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2016-02-03 | 3627 University Boulevard, South, Suite 615, JACKSONVILLE, FL 32216 | No data |
| LC AMENDMENT AND NAME CHANGE | 2011-03-24 | JACKSONVILLE MULTISPECIALTY GROUP, LLC | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-24 |
| ANNUAL REPORT | 2023-04-07 |
| AMENDED ANNUAL REPORT | 2022-02-03 |
| ANNUAL REPORT | 2022-02-02 |
| CORLCRACHG | 2021-11-12 |
| ANNUAL REPORT | 2021-02-03 |
| ANNUAL REPORT | 2020-04-01 |
| ANNUAL REPORT | 2019-03-30 |
| ANNUAL REPORT | 2018-03-20 |
| ANNUAL REPORT | 2017-04-04 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
