| Entity Name: | ASCENSION INTERNAL MEDICINE OF FLORIDA, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 30 May 2012 (13 years ago) |
| Document Number: | L12000072045 |
| FEI/EIN Number | 45-5378347 |
| Address: | 1426 CANYON AVE NE, LIVE OAK, FL, 32064, US |
| Mail Address: | 14513 NW 45th Pl, Newberry, FL, 32669, US |
| ZIP code: | 32064 |
| County: | Suwannee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1811233505 | 2012-12-27 | 2020-12-10 | 8924 SW 15TH AVE, GAINESVILLE, FL, 326077014, US | 1426 CANYON AVE NE STE C, LIVE OAK, FL, 320644832, US | |||||||||||||||||||||||
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| Phone | +1 269-277-3536 |
| Phone | +1 386-208-0537 |
| Fax | 3862080571 |
Authorized person
| Name | DR. MALIK M NAQI |
| Role | DIRECTOR |
| Phone | 3862080537 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 008086300 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| NAQI MALIK | Agent | 14513 NW 45TH PLACE, NEWBERRY, FL, 32669 |
| Name | Role | Address |
|---|---|---|
| TAQI MOHAMMAD | Manager | 14609 NW 45th PLACE, NEWBERRY, FL, 32669 |
| NAQI MALIK M | Manager | 14513 NW 45TH PLACE, NEWBERRY, FL, 32669 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2021-04-29 | 1426 CANYON AVE NE, SUITE C, LIVE OAK, FL 32064 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2020-05-28 | 1426 CANYON AVE NE, SUITE C, LIVE OAK, FL 32064 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-05-28 | 14513 NW 45TH PLACE, NEWBERRY, FL 32669 | No data |
| REGISTERED AGENT NAME CHANGED | 2017-03-29 | NAQI, MALIK | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-22 |
| ANNUAL REPORT | 2023-04-25 |
| ANNUAL REPORT | 2022-04-28 |
| ANNUAL REPORT | 2021-04-29 |
| ANNUAL REPORT | 2020-05-28 |
| ANNUAL REPORT | 2019-04-22 |
| ANNUAL REPORT | 2018-04-09 |
| ANNUAL REPORT | 2017-03-29 |
| ANNUAL REPORT | 2016-04-11 |
| ANNUAL REPORT | 2015-03-05 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
