| Entity Name: | FT. WALTON BEACH INTERNAL MEDICINE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Inactive |
| Date Filed: | 18 May 2006 (19 years ago) |
| Date of dissolution: | 30 Dec 2010 (14 years ago) |
| Last Event: | LC VOLUNTARY DISSOLUTION |
| Event Date Filed: | 30 Dec 2010 (14 years ago) |
| Document Number: | L06000051752 |
| FEI/EIN Number | 56-2585144 |
| Address: | ONE PARK PLAZA, NASHVILLE, TN 37203 |
| Mail Address: | ONE PARK PLAZA, NASHVILLE, TN 37203 |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1912928896 | 2006-07-23 | 2008-06-23 | 1032 MAR WALT DR, SUITE 230, FORT WALTON BEACH, FL, 325476645, US | 1032 MAR WALT DR, SUITE 230, FORT WALTON BEACH, FL, 325476645, US | |||||||||||||||
|
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| Phone | +1 850-862-0318 |
| Fax | 8508622887 |
Authorized person
| Name | MICKEY PICKLER |
| Role | VP |
| Phone | 8505232117 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | Yes |
| Name | Role |
|---|---|
| C T CORPORATION SYSTEM | Agent |
| Name | Role | Address |
|---|---|---|
| MOORE, A. BRUCE JR | Manager | ONE PARK PLAZA, NASHVILLE, TN 37203 |
| JOHNSON, R. MILTON | Manager | ONE PARK PLAZA, NASHVILLE, TN 37203 |
| RUTHERFORD, WILLIAM B | Manager | ONE PARK PLAZA, NASHVILLE, TN 37203 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC VOLUNTARY DISSOLUTION | 2010-12-30 | No data | No data |
| Name | Date |
|---|---|
| LC Voluntary Dissolution | 2010-12-30 |
| ANNUAL REPORT | 2010-04-22 |
| ANNUAL REPORT | 2009-03-30 |
| ANNUAL REPORT | 2008-04-16 |
| ANNUAL REPORT | 2007-05-01 |
| Florida Limited Liability | 2006-05-18 |
Date of last update: 03 Jan 2025
Sources: Florida Department of State
