| Entity Name: | MONROSE CLINIC, ASSOCIATES FOR PSYCHOLOGICAL MEDICINE, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 08 Apr 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: | L08000035794 |
| FEI/EIN Number | 593033202 |
| Address: | 3169 Parador Way, JACKSONVILLE, FL, 32246, US |
| Mail Address: | 3169 Parador Way, JACKSONVILLE, FL, 32246, US |
| ZIP code: | 32246 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 1902076524 | 2008-03-11 | 2013-09-17 | 3627 UNIVERSITY BLVD S STE 615, JACKSONVILLE, FL, 322167401, US | 3627 UNIVERSITY BLVD SOUTH SUITE 615, JACKSONVILLE, FL, 322162721, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 904-725-6463 |
| Fax | 9047245006 |
Authorized person
| Name | DR. ATUL M SHAH |
| Role | PSYCHIATRISTS |
| Phone | 9047256463 |
Taxonomy
| Taxonomy Code | 101YM0800X - Mental Health Counselor |
| License Number | ME0048902 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | TRICARE |
| Number | 081686072 |
| State | FL |
| Issuer | CHAMPUS |
| Number | 081686072 |
| State | FL |
| Issuer | AETNA |
| Number | 4115015 |
| State | FL |
| Issuer | BLUE CROSS |
| Number | 14203 |
| State | FL |
| Issuer | MAGELLAN |
| Number | 016627000 |
| State | FL |
| Issuer | WELLCARE |
| Number | 05770 |
| State | FL |
| Issuer | MEDICAID |
| Number | 043765400 |
| State | FL |
| Issuer | UNITED BEHAVIORAL HEALTH |
| Number | 05770 |
| State | FL |
| Issuer | FIRST HEALTH |
| Number | 081686072 |
| State | FL |
| Issuer | VALUE OPTIONS |
| Number | 088657 |
| State | FL |
| Issuer | GA. MEDICAID |
| Number | 256262286A |
| State | GA |
| Name | Role | Address |
|---|---|---|
| SHAH ATUL M | Agent | 3169 Parador Way, JACKSONVILLE, FL, 32246 |
| Name | Role | Address |
|---|---|---|
| SHAH ATUL MMD | Managing Member | 3169 Parador Way, JACKSONVILLE, FL, 32246 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2021-09-24 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2019-09-26 | 3169 Parador Way, JACKSONVILLE, FL 32246 | No data |
| CHANGE OF MAILING ADDRESS | 2019-09-26 | 3169 Parador Way, JACKSONVILLE, FL 32246 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2019-09-26 | 3169 Parador Way, JACKSONVILLE, FL 32246 | No data |
| LC NAME CHANGE | 2010-08-02 | MONROSE CLINIC, ASSOCIATES FOR PSYCHOLOGICAL MEDICINE, PLLC | No data |
| CONVERSION | 2008-04-08 | No data | CORPORATION WAS A CONVERSION RESULT. CONVERTING CORPORATION WAS S10096. CONVERSION NUMBER 300000086583 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2020-01-31 |
| ANNUAL REPORT | 2019-09-26 |
| ANNUAL REPORT | 2018-04-19 |
| ANNUAL REPORT | 2017-02-22 |
| ANNUAL REPORT | 2016-04-29 |
| ANNUAL REPORT | 2015-05-01 |
| ANNUAL REPORT | 2014-04-14 |
| ANNUAL REPORT | 2013-04-15 |
| ANNUAL REPORT | 2012-04-11 |
| ANNUAL REPORT | 2011-03-23 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
