| Entity Name: | MRI ASSOCIATES OF LAKELAND LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 16 Apr 2010 (15 years ago) |
| Last Event: | LC STMNT OF RA/RO CHG |
| Event Date Filed: | 19 Dec 2023 (a year ago) |
| Document Number: | L10000041248 |
| FEI/EIN Number | 272366208 |
| Address: | 2946 LAKELAND HIGHLAND ROAD, LAKELAND, FL, 33803 |
| Mail Address: | 2946 LAKELAND HIGHLAND ROAD, LAKELAND, FL, 33803, US |
| ZIP code: | 33803 |
| County: | Polk |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1982925269 | 2010-06-21 | 2023-07-17 | 2946 LAKELAND HIGHLANDS RD, UNIT 12, LAKELAND, FL, 338034379, US | 2946 LAKELAND HIGHLANDS RD, LAKELAND, FL, 338034379, US | |||||||||||||||||||||||||||||||||||
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| Phone | +1 863-510-5944 |
| Fax | 8635105939 |
Authorized person
| Name | AMANDA MAPLE |
| Role | CAO |
| Phone | 7277876900 |
Taxonomy
| Taxonomy Code | 2085R0202X - Diagnostic Radiology Physician |
| Is Primary | No |
| Taxonomy Code | 261QR0200X - Radiology Clinic/Center |
| License Number | HCC8851 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS |
| Number | V004B |
| State | FL |
| Issuer | MEDICAID |
| Number | 112520700 |
| State | FL |
| Name | Role |
|---|---|
| CORPORATION SERVICE COMPANY | Agent |
| Name | Role | Address |
|---|---|---|
| David Gregory S | Chief Executive Officer | 32615 US Highway N, Palm Harbor, FL, 34684 |
| DIECIDUE FRANK J | Chief Executive Officer | 32615 US Highway N, Palm Harbor, FL, 34684 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G16000072392 | HIGHLAND MRI | ACTIVE | 2016-07-21 | 2027-12-31 | No data | 32615 US HWY 19 N STE 4, PALM HARBOR, FL, 34684 |
| G10000038576 | HIGHLAND MRI | EXPIRED | 2010-04-29 | 2015-12-31 | No data | 2946 LAKELAND HIGHLANDS ROAD, LAKELAND, FL, 33803 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2024-04-17 | 2946 LAKELAND HIGHLAND ROAD, LAKELAND, FL 33803 | No data |
| LC STMNT OF RA/RO CHG | 2023-12-19 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2023-12-19 | CORPORATION SERVICE COMPANY | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-12-19 | 1201 HAYS STREET, TALLAHASSEE, FL 32301-2525 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-17 |
| CORLCRACHG | 2023-12-19 |
| ANNUAL REPORT | 2023-01-28 |
| ANNUAL REPORT | 2022-04-06 |
| ANNUAL REPORT | 2021-01-04 |
| ANNUAL REPORT | 2020-01-29 |
| ANNUAL REPORT | 2019-03-01 |
| ANNUAL REPORT | 2018-01-08 |
| ANNUAL REPORT | 2017-01-21 |
| ANNUAL REPORT | 2016-03-09 |
Date of last update: 03 Jan 2025
Sources: Florida Department of State
