| Entity Name: | LAKE SHORE HMA MEDICAL GROUP, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 26 May 2010 (15 years ago) |
| Last Event: | LC STMNT OF RA/RO CHG |
| Event Date Filed: | 25 Feb 2014 (11 years ago) |
| Document Number: | L10000057151 |
| FEI/EIN Number | 272695213 |
| Address: | 4000 MERIDIAN BLVD, FRANKLIN, TN, 37067, US |
| Mail Address: | 4000 MERIDIAN BLVD, FRANKLIN, TN, 37067, US |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1215256458 | 2010-05-27 | 2019-05-15 | PO BOX 689022, FRANKLIN, TN, 370689022, US | 348 NE METHODIST TER STE 104, LAKE CITY, FL, 320553408, US | |||||||||||||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 615-465-7000 |
| Phone | +1 386-292-8024 |
Authorized person
| Name | JAMES P WRIGHT |
| Role | VP PHYSICIAN BUSINESS SERVICES |
| Phone | 6157781502 |
Taxonomy
| Taxonomy Code | 207L00000X - Anesthesiology Physician |
| Is Primary | No |
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 207RC0000X - Cardiovascular Disease Physician |
| Is Primary | No |
| Taxonomy Code | 207X00000X - Orthopaedic Surgery Physician |
| Is Primary | No |
| Taxonomy Code | 208000000X - Pediatrics Physician |
| Is Primary | No |
| Taxonomy Code | 208600000X - Surgery Physician |
| Is Primary | Yes |
| Taxonomy Code | 363L00000X - Nurse Practitioner |
| Is Primary | No |
| Taxonomy Code | 367500000X - Certified Registered Nurse Anesthetist |
| Is Primary | No |
| Name | Role |
|---|---|
| CORPORATION SERVICE COMPANY | Agent |
| Name | Role | Address |
|---|---|---|
| Hammons Kevin J | Manager | 4000 MERIDIAN BLVD, FRANKLIN, TN, 37067 |
| Pitt Justin D | Manager | 4000 MERIDIAN BLVD, FRANKLIN, TN, 37067 |
| Cash W. B | Manager | 4000 MERIDIAN BLVD, FRANKLIN, TN, 37067 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G18000092456 | SHANDS LAKE SHORE MEDICAL GROUP | EXPIRED | 2018-08-20 | 2023-12-31 | No data | 4000 MERIDIAN BLVD., FRANKLIN, TN, 37067 |
| G16000030622 | LAKE SHORE OBSTETRICS AND GYNECOLOGY | EXPIRED | 2016-03-24 | 2021-12-31 | No data | 348 NE METHODIST TERRACE, LAKE CITY, FL, 32055 |
| G15000118820 | LAKE SHORE PRIMARY CARE | EXPIRED | 2015-11-23 | 2020-12-31 | No data | 4241 NW AMERICAN LANE, LAKE CITY, FL, 32055 |
| G15000083096 | LAKE SHORE CARDIOLOGY | EXPIRED | 2015-08-11 | 2020-12-31 | No data | 351 NE FRANKLIN STREET, LAKE CITY, FL, 32055 |
| G12000047576 | INTERNAL MEDICINE OF LAKE CITY | EXPIRED | 2012-05-22 | 2017-12-31 | No data | 289 SW STONEGATE TERRACE, SUITE 204, LAKE CITY, FL, 32024 |
| G11000081028 | LAKE SHORE PEDIATRIC AND FAMILY MEDICINE | EXPIRED | 2011-08-15 | 2016-12-31 | No data | 5811 PELICAN BAY BLVD., SUITE 500, ATTN: LEGAL DEPARTMENT, NAPLES, FL, 34108 |
| G11000039455 | LAKE SHORE PRIMARY CARE-WEST | EXPIRED | 2011-04-22 | 2016-12-31 | No data | 5811 PELICAN BAY BLVD., SUITE 500, ATTN: LEGAL DEPARTMENT, NAPLES, FL, 34108 |
| G10000117998 | SHANDS LAKE SHORE ORTHOPAEDIC AND SPORTS MEDICINE CENTER | EXPIRED | 2010-12-23 | 2015-12-31 | No data | 5811 PELICAN BAY BLVD., SUITE 500, ATTN: LEGAL DEPARTMENT, NAPLES, FL, 34108 |
| G10000061350 | LAKE SHORE SPORTS MEDICINE & MUSCULOSKELETAL CENTER | EXPIRED | 2010-07-02 | 2015-12-31 | No data | 5811 PELICAN BAY BLVD., SUITE 500, ATTN: LEGAL DEPARTMENT, NAPLES, FL, 34108 |
| G10000061353 | LAKE SHORE SURGICAL SPECIALISTS | EXPIRED | 2010-07-02 | 2015-12-31 | No data | 5811 PELICAN BAY BLVD., SUITE 500, ATTN: LEGAL DEPARTMENT, NAPLES, FL, 34108 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2014-05-01 | 4000 MERIDIAN BLVD, FRANKLIN, TN 37067 | No data |
| CHANGE OF MAILING ADDRESS | 2014-05-01 | 4000 MERIDIAN BLVD, FRANKLIN, TN 37067 | No data |
| LC STMNT OF RA/RO CHG | 2014-02-25 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2014-02-25 | CORPORATION SERVICE COMPANY | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2014-02-25 | 1201 HAYS STREET, TALLAHASSEE, FL 32301-2525 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-25 |
| ANNUAL REPORT | 2023-04-12 |
| ANNUAL REPORT | 2022-04-23 |
| ANNUAL REPORT | 2021-04-23 |
| ANNUAL REPORT | 2020-05-03 |
| ANNUAL REPORT | 2019-04-26 |
| ANNUAL REPORT | 2018-04-25 |
| ANNUAL REPORT | 2017-04-18 |
| ANNUAL REPORT | 2016-04-28 |
| ANNUAL REPORT | 2015-04-21 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
