| Entity Name: | JOHN BODEN, MD, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 27 Jun 2008 (17 years ago) |
| Date of dissolution: | 17 Mar 2011 (14 years ago) |
| Last Event: | LC VOLUNTARY DISSOLUTION |
| Event Date Filed: | 17 Mar 2011 (14 years ago) |
| Document Number: | L08000063237 |
| FEI/EIN Number | 262963681 |
| Address: | 42 INDIAN BAYOU DR, DESTIN, FL, 32541, US |
| Mail Address: | 42 INDIAN BAYOU DR, DESTIN, FL, 32541, US |
| ZIP code: | 32541 |
| County: | Okaloosa |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1275789711 | 2008-08-15 | 2008-12-22 | 42 INDIAN BAYOU DR, DESTIN, FL, 325414447, US | 6879 US HIGHWAY 98 W, SANTA ROSA BEACH, FL, 324593257, US | |||||||||||||||||||||||||||||||||||||
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| Phone | +1 850-502-1363 |
| Fax | 8508374837 |
Authorized person
| Name | DR. JOHN M BODEN |
| Role | PRESIDENT/PHYSICIAN |
| Phone | 8505021363 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | ME94719 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 009912339 |
| State | AL |
| Issuer | MEDICAID |
| Number | 044554100 |
| State | FL |
| Issuer | MEDICAID |
| Number | 009912342 |
| State | FL |
| Name | Role |
|---|---|
| CORPORATION SERVICE COMPANY | Agent |
| Name | Role | Address |
|---|---|---|
| BODEN JOHM M | Managing Member | 42 INDIAN BAYOU DR, DESTIN, FL, 32541 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC VOLUNTARY DISSOLUTION | 2011-03-17 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2010-09-24 | No data | No data |
| Name | Date |
|---|---|
| LC Voluntary Dissolution | 2011-03-17 |
| ANNUAL REPORT | 2009-07-02 |
| Florida Limited Liability | 2008-06-27 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
