| Entity Name: | PINNACLE RADIOLOGY LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 19 Dec 2007 (17 years ago) |
| Date of dissolution: | 27 Sep 2013 (11 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 27 Sep 2013 (11 years ago) |
| Document Number: | L07000125549 |
| FEI/EIN Number | 261596743 |
| Address: | 330 FIFTH AVE, INDIALANTIC, FL, 32903 |
| Mail Address: | 330 FIFTH AVE, INDIALANTIC, FL, 32903 |
| ZIP code: | 32903 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1205006343 | 2008-03-05 | 2011-02-23 | PO BOX 881839, PORT ST LUCIE, FL, 349881839, US | 490 N WASHINGTON AVE, TITUSVILLE, FL, 327962871, US | |||||||||||||||||||||||
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| Phone | +1 727-896-3134 |
| Fax | 7706669330 |
| Phone | +1 321-268-4200 |
Authorized person
| Name | KENNETH S HAZLETT |
| Role | MANAGING MEMBER |
| Phone | 3217999172 |
Taxonomy
| Taxonomy Code | 2085R0202X - Diagnostic Radiology Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICARE PTAN |
| Number | AM098 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| HILLEREN DAVID J | Agent | 330 FIFTH AVE, INDIALANTIC, FL, 32903 |
| Name | Role | Address |
|---|---|---|
| HILLEREN DAVID J | Managing Member | 330 FIFTH AVE, INDIALANTIC, FL, 32903 |
| BERGAU DIANE M | Managing Member | 330 FIFTH AVE, INDIALANTIC, FL, 32903 |
| GORDON DOUGLAS M | Managing Member | 330 FIFTH AVE, INDIALANTIC, FL, 32903 |
| HAZLETT KENNETH M | Managing Member | 330 FIFTH AVE, INDIALANTIC, FL, 32903 |
| FORREST DANIEL D | Managing Member | 330 FIFTH AVE, INDIALANTIC, FL, 32903 |
| HATTAWAY AARON J | Managing Member | 330 FIFTH AVE, INDIALANTIC, FL, 32903 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2013-09-27 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2012-04-27 |
| ANNUAL REPORT | 2011-04-29 |
| ANNUAL REPORT | 2010-04-28 |
| ANNUAL REPORT | 2009-04-28 |
| Florida Limited Liability | 2007-12-19 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
