| Entity Name: | INSTITUTE OF CARDIOVASCULAR MEDICINE, L.L.C. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 21 Dec 2006 (18 years ago) |
| Date of dissolution: | 03 Dec 2021 (3 years ago) |
| Last Event: | LC STMNT OF TERM |
| Event Date Filed: | 03 Dec 2021 (3 years ago) |
| Document Number: | L06000121953 |
| FEI/EIN Number | 593321229 |
| Mail Address: | P.O. BOX 2050, OCALA, FL, 34478 |
| Address: | 10435 SE 170TH PLACE, SUMMERFIELD, FL, 34491 |
| ZIP code: | 34491 |
| County: | Marion |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1952325490 | 2006-07-27 | 2009-10-07 | PO BOX 919298, ORLANDO, FL, 328919298, US | 10435 SE 170TH PL, SUMMERFIELD, FL, 344918998, US | |||||||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||||||
| Phone | +1 352-624-7384 |
| Fax | 3526247385 |
| Phone | +1 352-347-7923 |
| Fax | 3523476181 |
Authorized person
| Name | DR. ALI NASSER |
| Role | PHYSICIAN |
| Phone | 3522910166 |
Taxonomy
| Taxonomy Code | 207RC0000X - Cardiovascular Disease Physician |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS |
| Number | 40773 |
| State | FL |
| Issuer | MEDICAID |
| Number | 262215700 |
| State | FL |
| Issuer | RR MEDICARE |
| Number | CD5197 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| THE MILLHORN LAW FIRM, LLC | Agent | 13710 US HIGHWAY 441, STE. 100, LADY LAKE, FL, 32159 |
| Name | Role | Address |
|---|---|---|
| JUSTIN FERNS | Manager | 10435 SE 170TH PLACE, SUMMERFIELD, FL, 34491 |
| NASSER ALI M | Manager | 10435 SE 170TH PLACE, SUMMERFIELD, FL, 34491 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G08136900291 | INSTITUTE OF CARDIOVASCULAR MEDICINE | EXPIRED | 2008-05-15 | 2013-12-31 | No data | 3310 SW 34TH STREET, OCALA, FL, 34474 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC STMNT OF TERM | 2021-12-03 | No data | No data |
| LC VOLUNTARY DISSOLUTION | 2021-02-08 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2013-09-27 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2012-04-21 | 10435 SE 170TH PLACE, SUMMERFIELD, FL 34491 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2012-04-21 | 10435 SE 170TH PLACE, SUMMERFIELD, FL 34491 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2009-04-07 | 13710 US HIGHWAY 441, STE. 100, LADY LAKE, FL 32159 | No data |
| REGISTERED AGENT NAME CHANGED | 2009-04-07 | THE MILLHORN LAW FIRM, LLC | No data |
| LC AMENDED AND RESTATED ARTICLES | 2009-04-07 | No data | No data |
| LC AMENDMENT AND NAME CHANGE | 2008-11-10 | INSTITUTE OF CARDIOVASCULAR MEDICINE, L.L.C. | No data |
| LC AMENDMENT | 2008-06-02 | No data | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J12000924657 | LAPSED | 42-2012-CA-002207-AXXXX-XX | MARION COUNTY | 2012-11-16 | 2017-12-05 | $86,210.77 | R.H.DONNELLEY, INC., C/O FOSTER & KLINKBEIL, P.A., P.O. BOX 3108, ORLANDO, FL 32802 |
| J12000597081 | LAPSED | 2010 CA 010003 NC | SARASOTA COUNTY TWELFTH JC | 2012-08-28 | 2017-09-12 | $86,000.00 | PREMIER PHYSICIAN MANAGEMENT SERVICES, LLC, 6802 ENERGY COURT, SARASOTA, FL 34240 |
| J11000297593 | TERMINATED | 2011-140-CC | MARION COUNTY | 2011-05-03 | 2016-05-16 | $8,207.05 | BRACCO DIAGNOSTICS, INC., P.O. BOX 532411, CHARLOTTE, NC 28290-2411 |
| Name | Date |
|---|---|
| CORLCSTERM | 2021-12-03 |
| LC Voluntary Dissolution | 2021-02-08 |
| ANNUAL REPORT | 2012-04-21 |
| ANNUAL REPORT | 2011-04-29 |
| ANNUAL REPORT | 2010-01-22 |
| ANNUAL REPORT | 2009-04-09 |
| LC Amended and Restated Art | 2009-04-07 |
| LC Amendment and Name Change | 2008-11-10 |
| ANNUAL REPORT | 2008-07-17 |
| LC Amendment | 2008-06-02 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
