| Entity Name: | BOUTWELL MEDICAL ASSOCIATES, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 12 Mar 2008 (17 years ago) |
| Date of dissolution: | 24 Sep 2021 (3 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 24 Sep 2021 (3 years ago) |
| Document Number: | L08000026240 |
| FEI/EIN Number | NOT APPLICABLE |
| Address: | 2328 10th Ave N, Suite 300-301, LAKE WORTH BEACH, FL, 33461, US |
| Mail Address: | 2328 10th Ave N, Suite 300-301, LAKE WORTH BEACH, FL, 33461, US |
| ZIP code: | 33461 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1619121340 | 2008-11-07 | 2011-01-31 | PO BOX 7240, JUPITER, FL, 334687240, US | 3185 BOUTWELL RD, LAKE WORTH, FL, 334612610, US | |||||||||||||||||
|
|||||||||||||||||||||
| Phone | +1 561-748-2889 |
| Fax | 5617481523 |
| Phone | +1 561-533-0074 |
Authorized person
| Name | MORGAN PONCY |
| Role | MEDICAL DIRECTOR |
| Phone | 5617482889 |
Taxonomy
| Taxonomy Code | 207RA0401X - Addiction Medicine (Internal Medicine) Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| NASON NATHAN E | Agent | 3001 PGA BLVD., PALM BEACH GARDENS, FL, 33410 |
| Name | Role | Address |
|---|---|---|
| DORAN TIMOTHY | Manager | 2328 10th Ave, LAKE WORTH BEACH, FL, 33461 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2021-09-24 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2020-03-12 | 2328 10th Ave N, Suite 300-301, LAKE WORTH BEACH, FL 33461 | No data |
| CHANGE OF MAILING ADDRESS | 2020-03-12 | 2328 10th Ave N, Suite 300-301, LAKE WORTH BEACH, FL 33461 | No data |
| REGISTERED AGENT NAME CHANGED | 2019-01-08 | NASON, NATHAN E | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2018-02-13 | 3001 PGA BLVD., #305, PALM BEACH GARDENS, FL 33410 | No data |
| LC AMENDMENT | 2012-03-15 | No data | No data |
| REINSTATEMENT | 2011-10-12 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2009-09-25 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2020-03-12 |
| ANNUAL REPORT | 2019-01-08 |
| ANNUAL REPORT | 2018-02-13 |
| ANNUAL REPORT | 2017-01-26 |
| ANNUAL REPORT | 2016-03-28 |
| ANNUAL REPORT | 2015-04-03 |
| ANNUAL REPORT | 2014-04-18 |
| ANNUAL REPORT | 2013-04-25 |
| ANNUAL REPORT | 2012-04-26 |
| LC Amendment | 2012-03-15 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
