| Entity Name: | FORT MYERS FAMILY MEDICINE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Florida Limited Liability Co.
FORT MYERS FAMILY MEDICINE, LLC is structured as a Limited Liability Company (LLC), a common business structure that offers its members limited liability protection, separating their personal assets from the company's debts and obligations. |
| Status: |
Inactive
The business entity is inactive. This status may signal operational issues or voluntary closure, raising concerns about the business's ability to repay loans and requiring careful risk assessment by lenders. |
| Date Filed: | 27 Jun 2011 (14 years ago) |
| Date of dissolution: | 30 Apr 2019 (6 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 30 Apr 2019 (6 years ago) |
| Document Number: | L11000074767 |
| FEI/EIN Number |
650938486
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 15661 SAN CARLOS BLVD., SUITE 2, FORT MYERS, FL, 33908 |
| Mail Address: | 15661 SAN CARLOS BLVD., SUITE 2, FORT MYERS, FL, 33908 |
| ZIP code: | 33908 |
| County: | Lee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1255436143 | 2006-09-14 | 2018-06-20 | 15661 SAN CARLOS BLVD, SUITE 2, FORT MYERS, FL, 339082797, US | 15661 SAN CARLOS BLVD, SUITE 2, FORT MYERS, FL, 33908, US | |||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||
| Phone | +1 239-433-4014 |
| Fax | 2394816247 |
Authorized person
| Name | DR. HURSEL LEE ADKINS JR. |
| Role | EXECUTIVE MANAGING DIRECTOR |
| Phone | 2394334014 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | OS0005720 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 268237100 |
| State | FL |
| Issuer | MEDICARE PTAN |
| Number | K1484 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| ADKINS H. LEE | Manager | 15661 SAN CARLOS BLVD., SUITE 2, FORT MYERS, FL, 33908 |
| KYLE KEVIN A | Agent | 1380 ROYAL PALM SQUARE BLVD., FORT MYERS, FL, 33919 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2019-04-30 | - | - |
| CONVERSION | 2011-06-27 | - | CORPORATION WAS A CONVERSION RESULT. CONVERTING CORPORATION WAS P99000066407. CONVERSION NUMBER 100000114711 |
| Name | Date |
|---|---|
| VOLUNTARY DISSOLUTION | 2019-04-30 |
| ANNUAL REPORT | 2018-06-26 |
| ANNUAL REPORT | 2017-04-27 |
| ANNUAL REPORT | 2016-04-29 |
| ANNUAL REPORT | 2015-04-28 |
| ANNUAL REPORT | 2014-03-13 |
| ANNUAL REPORT | 2013-04-16 |
| ANNUAL REPORT | 2012-01-04 |
| Florida Limited Liability | 2011-06-27 |
Date of last update: 02 Apr 2025
Sources: Florida Department of State
