| Entity Name: | ST. JOSEPH'S DIAGNOSTIC CENTER, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 29 Nov 2007 (17 years ago) |
| Last Event: | CONVERSION |
| Event Date Filed: | 29 Nov 2007 (17 years ago) |
| Document Number: | L07000119531 |
| FEI/EIN Number | 592820952 |
| Address: | 3001 WEST DR. MARTIN LUTHER KING JR. BLVD., TAMPA, FL, 33607 |
| Mail Address: | 3001 WEST DR. MARTIN LUTHER KING JR. BLVD., TAMPA, FL, 33607 |
| ZIP code: | 33607 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1821527474 | 2017-06-07 | 2019-01-18 | 2995 DREW ST FL 2, CLEARWATER, FL, 337593012, US | 17512 DONA MICHELLE DR STE 5, TAMPA, FL, 336473265, US | |||||||||||||||||||||||
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| Phone | +1 727-281-9065 |
| Fax | 8136352613 |
| Phone | +1 813-586-7650 |
Authorized person
| Name | TAMBLYN CUBERO |
| Role | VP |
| Phone | 7272819093 |
Taxonomy
| Taxonomy Code | 2085R0202X - Diagnostic Radiology Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 061048806 |
| State | FL |
| Name | Role |
|---|---|
| BAYCARE HEALTH SYSTEM, INC. | Agent |
| Name | Role |
|---|---|
| ST. JOSEPH'S ENTERPRISES, INC. | Authorized Member |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G15000081250 | BAYCARE OUTPATIENT CENTER | ACTIVE | 2015-08-06 | 2025-12-31 | No data | 12780 RACE TRACK ROAD, TAMPA, FL, 33626 |
| G09000161628 | BAYCARE OUTPATIENT IMAGING | EXPIRED | 2009-10-02 | 2014-12-31 | No data | 3001 W DR. MARTIN LUTHER KING JR BLVD, TAMPA, FL, 33607 |
| G09000161631 | BAYCARE OUTPATIENT IMAGING | ACTIVE | 2009-10-02 | 2029-12-31 | No data | 3890 TAMPA ROAD, PALM HARBOR, FL, 34684 |
| G09000151138 | BAYCARE OUTPATIENT CENTER | EXPIRED | 2009-08-31 | 2014-12-31 | No data | 12780 RACE TRACK ROAD, TAMPA, FL, 33626 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2023-03-02 | BAYCARE HEALTH SYSTEM, INC. | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2014-04-15 | ATTENTION: LEGAL SERVICES DEPARTMENT, 2985 DREW STREET, CLEARWATER, FL 33759 | No data |
| CONVERSION | 2007-11-29 | No data | CORPORATION WAS A CONVERSION RESULT. CONVERTING CORPORATION WAS A23662. CONVERSION NUMBER 700000069837 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-04 |
| ANNUAL REPORT | 2023-03-02 |
| AMENDED ANNUAL REPORT | 2022-10-07 |
| ANNUAL REPORT | 2022-03-01 |
| ANNUAL REPORT | 2021-03-02 |
| ANNUAL REPORT | 2020-02-03 |
| ANNUAL REPORT | 2019-02-05 |
| ANNUAL REPORT | 2018-03-30 |
| ANNUAL REPORT | 2017-04-19 |
| ANNUAL REPORT | 2016-02-15 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
