| Entity Name: | THE LABORATORY GROUP OF NORTHWEST FLORIDA, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 19 Apr 2009 (16 years ago) |
| Date of dissolution: | 23 Sep 2016 (8 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 23 Sep 2016 (8 years ago) |
| Document Number: | L09000037700 |
| FEI/EIN Number | 611595918 |
| Address: | 4724 NORTH DAVIS HWY, 2ND FLOOR, PENSACOLA, FL, 32503 |
| Mail Address: | 4724 NORTH DAVIS HWY, 2ND FLOOR, PENSACOLA, FL, 32503 |
| ZIP code: | 32503 |
| County: | Escambia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1366674004 | 2009-08-13 | 2010-08-11 | 4724 N DAVIS HWY, 2ND FLOOR, PENSACOLA, FL, 325032339, US | 4724 N DAVIS HWY, 2ND FLOOR, PENSACOLA, FL, 325032339, US | |||||||||||||||||||||
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| Phone | +1 850-438-1154 |
| Fax | 8504336034 |
Authorized person
| Name | NORTH JOSEPH DAVIS |
| Role | LABORATORY DIRECTOR |
| Phone | 8504381154 |
Taxonomy
| Taxonomy Code | 291U00000X - Clinical Medical Laboratory |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 001697200 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| DAVIS NORTH J | Agent | 4724 NORTH DAVIS HWY, PENSACOLA, FL, 32503 |
| Name | Role | Address |
|---|---|---|
| DAVIS NORTH J | President | 4724 NORTH DAVIS HWY 2ND FLOOR, PENSACOLA, FL, 32503 |
| Name | Role | Address |
|---|---|---|
| DAVIS NORTH J | Treasurer | 4724 NORTH DAVIS HWY 2ND FLOOR, PENSACOLA, FL, 32503 |
| Name | Role | Address |
|---|---|---|
| CANDELA ANDRES M | Vice President | 4724 NORTH DAVIS 2ND FLOOR, PENSACOLA, FL, 32503 |
| Name | Role | Address |
|---|---|---|
| CANDELA ANDRES M | Secretary | 4724 NORTH DAVIS 2ND FLOOR, PENSACOLA, FL, 32503 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G12000074641 | QUANTUM LABORATORY SERVICES | EXPIRED | 2012-07-27 | 2017-12-31 | No data | 4724 NORTH DAVIS HIGHWAY, 2ND FLOOR, PENSACOLA, FL, 32503 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2016-09-23 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2010-11-23 | DAVIS, NORTH JM.D. | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2010-01-29 | 4724 NORTH DAVIS HWY, 2ND FLOOR, PENSACOLA, FL 32503 | No data |
| CHANGE OF MAILING ADDRESS | 2010-01-29 | 4724 NORTH DAVIS HWY, 2ND FLOOR, PENSACOLA, FL 32503 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2010-01-29 | 4724 NORTH DAVIS HWY, 2ND FLOOR, PENSACOLA, FL 32503 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2015-02-05 |
| ANNUAL REPORT | 2014-02-06 |
| ANNUAL REPORT | 2013-02-28 |
| ANNUAL REPORT | 2012-03-05 |
| ANNUAL REPORT | 2011-02-21 |
| Reg. Agent Change | 2010-11-23 |
| ANNUAL REPORT | 2010-01-29 |
| Florida Limited Liability | 2009-04-19 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
