| Entity Name: | BREVARD HMA DIAGNOSTIC IMAGING, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Inactive |
| Date Filed: | 23 Aug 2010 (14 years ago) |
| Date of dissolution: | 20 Oct 2023 (a year ago) |
| Last Event: | LC VOLUNTARY DISSOLUTION |
| Event Date Filed: | 20 Oct 2023 (a year ago) |
| Document Number: | L10000088458 |
| FEI/EIN Number | 27-3138738 |
| Address: | 4000 Meridian Boulevard, Franklin, TN 37067 |
| Mail Address: | 4000 Meridian Boulevard, Franklin, TN 37067 |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1912036781 | 2007-03-05 | 2011-09-20 | 7970 N WICKHAM RD, MELBOURNE, FL, 329408299, US | 7970 N WICKHAM RD, MELBOURNE, FL, 329408299, US | |||||||||||||||||||||||||
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| Phone | +1 321-255-7711 |
| Fax | 3212557734 |
Authorized person
| Name | MR. TIMOTHY PARRY |
| Role | SR VP AND GENERAL COUNSEL |
| Phone | 2395983131 |
Taxonomy
| Taxonomy Code | 2085R0202X - Diagnostic Radiology Physician |
| License Number | HCC3598 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 051814000 |
| State | FL |
| Name | Role |
|---|---|
| CORPORATION SERVICE COMPANY | Agent |
| Name | Role | Address |
|---|---|---|
| Hammons, Kevin J. | Manager | 4000 Meridian Boulevard, Franklin, TN 37067 |
| Pitt, Justin D. | Manager | 4000 Meridian Boulevard, Franklin, TN 37067 |
| Cash , W. Bradley | Manager | 4000 Meridian Boulevard, Franklin, TN 37067 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G10000090468 | SUNTREE DIAGNOSTIC CENTER AND MAMMOGRAPHY CLINIC | EXPIRED | 2010-10-04 | 2015-12-31 | No data | 5811 PELICAN BAY BOULEVARD, SUITE 500, NAPLES, FL, 34108-2710 |
| G10000090469 | WUESTHOFF X-RAY AND LAB AT BAYTREE | EXPIRED | 2010-10-04 | 2015-12-31 | No data | 5811 PELICAN BAY BOULEVARD, SUITE 500, NAPLES, FL, 34108-2710 |
| G10000090470 | WUESTHOFF X-RAY AND LAB | EXPIRED | 2010-10-04 | 2015-12-31 | No data | 5811 PELICAN BAY BOULEVARD, SUITE 500, NAPLES, FL, 34108-2710 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC VOLUNTARY DISSOLUTION | 2023-10-20 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2019-04-25 | 4000 Meridian Boulevard, Franklin, TN 37067 | No data |
| CHANGE OF MAILING ADDRESS | 2019-04-25 | 4000 Meridian Boulevard, 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 |
|---|---|
| LC Voluntary Dissolution | 2023-10-20 |
| ANNUAL REPORT | 2023-04-12 |
| ANNUAL REPORT | 2022-04-23 |
| ANNUAL REPORT | 2021-04-22 |
| ANNUAL REPORT | 2020-04-14 |
| ANNUAL REPORT | 2019-04-25 |
| ANNUAL REPORT | 2018-04-21 |
| ANNUAL REPORT | 2017-04-18 |
| ANNUAL REPORT | 2016-04-29 |
| ANNUAL REPORT | 2015-04-21 |
Date of last update: 24 Jan 2025
Sources: Florida Department of State
