| Entity Name: | MEDICAL VITALITY CLINIC, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 25 Jun 2012 (13 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 17 Oct 2013 (11 years ago) |
| Document Number: | L12000084159 |
| FEI/EIN Number | 800829514 |
| Address: | 809 SW 18TH COURT, FT. LAUDERDALE, FL, 33315, US |
| Mail Address: | 809 SW 18TH COURT, FT. LAUDERDALE, FL, 33315, US |
| ZIP code: | 33315 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1043858012 | 2019-12-20 | 2019-12-20 | 1845 CORDOVA RD STE 204, FORT LAUDERDALE, FL, 333166100, US | 1845 CORDOVA RD STE 204, FORT LAUDERDALE, FL, 333166100, US | |||||||||||||
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| Phone | +1 954-361-3343 |
Authorized person
| Name | PATRICIA ANSON |
| Role | DELEGATED OFFICAL |
| Phone | 3052792276 |
Taxonomy
| Taxonomy Code | 207V00000X - Obstetrics & Gynecology Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| CHANNEY STEPHEN BMD | Agent | 809 SW 18TH COURT, FT. LAUDERDALE, FL, 33315 |
| Name | Role | Address |
|---|---|---|
| CHANNEY STEPHEN BMD | Managing Member | 809 SW 18TH COURT, FT. LAUDERDALE, FL, 33315 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G12000066285 | MEDICAL VITALITY | EXPIRED | 2012-07-02 | 2017-12-31 | No data | 5030 LINCOLN STREET, HOLLYWOOD, FL, 33021 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2022-03-18 | 809 SW 18TH COURT, FT. LAUDERDALE, FL 33315 | No data |
| CHANGE OF MAILING ADDRESS | 2022-03-18 | 809 SW 18TH COURT, FT. LAUDERDALE, FL 33315 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-03-18 | 809 SW 18TH COURT, FT. LAUDERDALE, FL 33315 | No data |
| REINSTATEMENT | 2013-10-17 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2013-10-17 | CHANNEY, STEPHEN B, MD | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2013-09-27 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-10 |
| ANNUAL REPORT | 2023-04-14 |
| ANNUAL REPORT | 2022-03-18 |
| ANNUAL REPORT | 2021-01-26 |
| ANNUAL REPORT | 2020-03-17 |
| ANNUAL REPORT | 2019-02-15 |
| ANNUAL REPORT | 2018-04-09 |
| ANNUAL REPORT | 2017-02-15 |
| ANNUAL REPORT | 2016-02-05 |
| ANNUAL REPORT | 2015-02-05 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
