| Entity Name: | NORTH FLORIDA ACUTE CARE SPECIALISTS, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 29 Jul 2008 (16 years ago) |
| Date of dissolution: | 25 Sep 2015 (9 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 25 Sep 2015 (9 years ago) |
| Document Number: | L08000072515 |
| FEI/EIN Number | 263061812 |
| Address: | 1392 EAGLE CROSSING DRIVE, ORANGE PARK, FL, 32065, US |
| Mail Address: | P.O. BOX 551698, JACKSONVILLE, FL, 32255-1698, US |
| ZIP code: | 32065 |
| County: | Clay |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1245489038 | 2008-09-16 | 2010-03-31 | PO BOX 551698, JACKSONVILLE, FL, 322551698, US | 5991 CHESTER AVE STE 211, JACKSONVILLE, FL, 322172245, US | |||||||||||||||||||||||||||||
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| Phone | +1 904-276-6903 |
| Fax | 8004310524 |
| Phone | +1 904-517-1400 |
Authorized person
| Name | DR. DASTAGIR KHAN |
| Role | MANAGING MEMBER |
| Phone | 9049557190 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 000767800 |
| State | FL |
| Issuer | BCBS |
| Number | 99966 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| RODRIGUEZ ISMAEL | Agent | 1392 EAGLE CROSSING DRIVE, ORANGE PARK, FL, 32065 |
| Name | Role | Address |
|---|---|---|
| HAVRYLIUK VLADIMIR | Managing Member | 13714 BROMELY POINT DRIVE, JACKSONVILLE, FL, 32225 |
| RODRIGUEZ ISMAEL | Managing Member | 1392 EAGLE CROSSING DRIVE, ORANGE PARK, FL, 32065 |
| TOUHEED MOHAMMAD | Managing Member | 13116 HIGHLAND GLEN WAY EAST, JACKSONVILLE, FL, 32224 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2015-09-25 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2012-03-21 | 1392 EAGLE CROSSING DRIVE, ORANGE PARK, FL 32065 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2012-03-21 | 1392 EAGLE CROSSING DRIVE, ORANGE PARK, FL 32065 | No data |
| REGISTERED AGENT NAME CHANGED | 2011-04-17 | RODRIGUEZ, ISMAEL | No data |
| LC AMENDMENT | 2010-12-06 | No data | No data |
| REINSTATEMENT | 2010-10-18 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2010-09-24 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2010-04-13 | 1392 EAGLE CROSSING DRIVE, ORANGE PARK, FL 32065 | No data |
| LC AMENDMENT | 2008-09-11 | No data | No data |
| LC AMENDMENT | 2008-09-10 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2014-03-26 |
| ANNUAL REPORT | 2013-03-10 |
| ANNUAL REPORT | 2012-03-21 |
| ANNUAL REPORT | 2011-04-17 |
| LC Amendment | 2010-12-06 |
| REINSTATEMENT | 2010-10-18 |
| ADDRESS CHANGE | 2010-04-13 |
| ANNUAL REPORT | 2009-01-20 |
| LC Amendment | 2008-09-10 |
| Florida Limited Liability | 2008-07-29 |
Date of last update: 02 Jan 2025
Sources: Florida Department of State
