| Entity Name: | BAYSIDE FAMILY HEALTHCARE CLEARWATER, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 01 Aug 2007 (18 years ago) |
| Date of dissolution: | 23 Sep 2011 (13 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 23 Sep 2011 (13 years ago) |
| Document Number: | L07000079084 |
| FEI/EIN Number | 352312012 |
| Address: | 107 MCMULLEN BOOTH ROAD NORTH, CLEARWATER, FL, 33759 |
| Mail Address: | 107 MCMULLEN BOOTH ROAD NORTH, CLEARWATER, FL, 33759 |
| ZIP code: | 33759 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1760791859 | 2010-10-06 | 2010-10-06 | 107 N MCMULLEN BOOTH RD, CLEARWATER, FL, 337594450, US | 107 N MCMULLEN BOOTH RD, CLEARWATER, FL, 337594450, US | |||||||||||||||||||||||||
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| Phone | +1 727-504-7073 |
| Fax | 8132003313 |
Authorized person
| Name | PATRICK E HICKEY |
| Role | MGRM |
| Phone | 7275047073 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | ME85120 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 274541100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| HICKEY PATRICK E | Agent | 107 MCMULLEN BOOTH ROAD NORTH, CLEARWATER, FL, 33759 |
| Name | Role | Address |
|---|---|---|
| HICKEY PATRICK E | Managing Member | 1775 SPLIT FORK DRIVE, OLDSMAR, FL, 34677 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2011-09-23 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2010-04-30 |
| ANNUAL REPORT | 2009-04-27 |
| ANNUAL REPORT | 2008-09-13 |
| Florida Limited Liability | 2007-08-01 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
