| Entity Name: | BON IMAGE LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 04 Jan 2012 (13 years ago) |
| Date of dissolution: | 22 Sep 2017 (7 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 22 Sep 2017 (7 years ago) |
| Document Number: | L12000002997 |
| FEI/EIN Number | 454283124 |
| Address: | 18705 Pepper Pike, Lutz, FL, 33558, US |
| Mail Address: | 18705 Pepper Pike, Lutz, FL, 33558, US |
| ZIP code: | 33558 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1457622557 | 2012-01-20 | 2014-05-05 | 15439 CORTEZ BLVD, BROOKSVILLE, FL, 346136113, US | 15439 CORTEZ BLVD, BROOKSVILLE, FL, 346136113, US | |||||||||||||||||||||||||||||||||||||
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| Phone | +1 352-593-4194 |
| Fax | 3525935828 |
Authorized person
| Name | DR. NARENDRA S SASTRY |
| Role | MANAGER |
| Phone | 8137860322 |
Taxonomy
| Taxonomy Code | 208G00000X - Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician |
| License Number | ME63006 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 371150100 |
| State | FL |
| Issuer | MEDICAID |
| Number | 064781100 |
| State | FL |
| Issuer | MEDICAID |
| Number | 006434900 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SASTRY NARENDRA | Agent | 18705 Pepper Pike, Lutz, FL, 33558 |
| Name | Role | Address |
|---|---|---|
| SASTRY NARENDRA | Managing Member | 18705 Pepper Pike, Lutz, FL, 33558 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G12000022504 | BON IMAGE | EXPIRED | 2012-03-05 | 2017-12-31 | No data | 5466 S. SUNCOAST BLVD, HOMOSASSA, FL, 34446 |
| G12000022511 | BON IMAGE VEIN AND LASER CENTER | EXPIRED | 2012-03-05 | 2017-12-31 | No data | 5466 S. SUNCOAST BLVD, HOMOSASSA, FL, 34446 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2017-09-22 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2015-01-19 | 18705 Pepper Pike, Lutz, FL 33558 | No data |
| CHANGE OF MAILING ADDRESS | 2015-01-19 | 18705 Pepper Pike, Lutz, FL 33558 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2015-01-19 | 18705 Pepper Pike, Lutz, FL 33558 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2016-04-21 |
| ANNUAL REPORT | 2015-01-19 |
| ANNUAL REPORT | 2014-01-16 |
| ANNUAL REPORT | 2013-04-01 |
| Florida Limited Liability | 2012-01-04 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
