| Entity Name: | INTERVASC AT BAY RADIOLOGY, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 31 Jul 2007 (18 years ago) |
| Document Number: | L07000078819 |
| FEI/EIN Number | 260857019 |
| Mail Address: | P.O. BOX 1770, PANAMA CITY, FL, 32402 |
| Address: | 521 NORTH PALO ALTO AVE, PANAMA CITY, FL, 32401, US |
| ZIP code: | 32401 |
| County: | Bay |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1942495916 | 2007-09-12 | 2014-08-18 | PO BOX 1770, PANAMA CITY, FL, 324021770, US | 527 N. PALO ALTO AVE., PANAMA CITY, FL, 324013639, US | |||||||||||||||||||||||||||||||
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| Phone | +1 850-747-4905 |
| Fax | 8507474907 |
| Phone | +1 850-873-3990 |
| Fax | 8508733974 |
Authorized person
| Name | DR. LLOYD G. LOGUE |
| Role | CEO |
| Phone | 8507474905 |
Taxonomy
| Taxonomy Code | 2085R0204X - Vascular & Interventional Radiology Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 279907300 |
| State | FL |
| Issuer | BCBS |
| Number | 98028 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| LOGUE LLOYD G | Agent | 521 NORTH PALO ALTO AVE, PANAMA CITY, FL, 32401 |
| Name | Role | Address |
|---|---|---|
| LOGUE LLOYD G | Managing Member | 521 NORTH PALO ALTO AVE, PANAMA CITY, FL, 32401 |
| BILLINGSLEY EMILY D | Managing Member | 521 NORTH PALO ALTO AVE, PANAMA CITY, FL, 32401 |
| WEINTRITT LINDSEY M | Managing Member | 521 NORTH PALO ALTO AVE, PANAMA CITY, FL, 32401 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2019-03-20 | 521 NORTH PALO ALTO AVE, PANAMA CITY, FL 32401 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2019-03-20 | 521 NORTH PALO ALTO AVE, PANAMA CITY, FL 32401 | No data |
| CHANGE OF MAILING ADDRESS | 2009-03-10 | 521 NORTH PALO ALTO AVE, PANAMA CITY, FL 32401 | No data |
| REGISTERED AGENT NAME CHANGED | 2009-03-10 | LOGUE, LLOYD G | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-13 |
| ANNUAL REPORT | 2023-02-16 |
| ANNUAL REPORT | 2022-02-08 |
| ANNUAL REPORT | 2021-02-12 |
| ANNUAL REPORT | 2020-04-17 |
| ANNUAL REPORT | 2019-03-20 |
| ANNUAL REPORT | 2018-03-22 |
| ANNUAL REPORT | 2017-02-02 |
| ANNUAL REPORT | 2016-04-06 |
| ANNUAL REPORT | 2015-04-11 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
