| Entity Name: | JACKSONVILLE KIDNEY CENTER, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 16 Aug 2010 (14 years ago) |
| Document Number: | L10000085483 |
| FEI/EIN Number | 273252093 |
| Address: | 13241 BARTRAM PARK BLVD., STE 409, JACKSONVILLE, FL, 32258, US |
| Mail Address: | 13241 BARTRAM PARK BLVD., STE 409, JACKSONVILLE, FL, 32258, US |
| ZIP code: | 32258 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1255647491 | 2010-08-25 | 2016-12-08 | 10036 DEERCREEK CLUB RD E, JACKSONVILLE, FL, 322561457, US | 13241 BARTRAM PARK BLVD UNIT 409, JACKSONVILLE, FL, 322585237, US | |||||||||||||||||||
|
|||||||||||||||||||||||
| Phone | +1 904-402-5137 |
| Phone | +1 904-400-6800 |
Authorized person
| Name | KOTESWARI KANCHA |
| Role | PRESIDENT |
| Phone | 9046478207 |
Taxonomy
| Taxonomy Code | 207RN0300X - Nephrology Physician |
| License Number | ME 98954 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| FARAH LAW | Agent | 6550 St. Augustine Road, JACKSONVILLE, FL, 32217 |
| Name | Role | Address |
|---|---|---|
| KANCHA KOTESWARI | Auth | 13241 BARTRAM PARK BLVD., STE 409, JACKSONVILLE, FL, 32258 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G10000097946 | JAX KIDNEY CENTER | EXPIRED | 2010-10-25 | 2015-12-31 | No data | 3993 REDS GAIT LANE, JACKSONVILLE, FL, 32223 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2018-03-06 | FARAH LAW | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2014-02-03 | 6550 St. Augustine Road, Suite 103, JACKSONVILLE, FL 32217 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2010-11-02 | 13241 BARTRAM PARK BLVD., STE 409, JACKSONVILLE, FL 32258 | No data |
| CHANGE OF MAILING ADDRESS | 2010-11-02 | 13241 BARTRAM PARK BLVD., STE 409, JACKSONVILLE, FL 32258 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-13 |
| ANNUAL REPORT | 2023-01-18 |
| ANNUAL REPORT | 2022-02-24 |
| ANNUAL REPORT | 2021-02-25 |
| ANNUAL REPORT | 2020-05-02 |
| ANNUAL REPORT | 2019-04-04 |
| ANNUAL REPORT | 2018-03-06 |
| ANNUAL REPORT | 2017-04-11 |
| ANNUAL REPORT | 2016-03-05 |
| ANNUAL REPORT | 2015-02-21 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
