| Entity Name: | BLUE WATER DOCTORS OF LAKE WORTH, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 24 Sep 2012 (12 years ago) |
| Date of dissolution: | 12 Jan 2016 (9 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 12 Jan 2016 (9 years ago) |
| Document Number: | L12000121869 |
| FEI/EIN Number | 46-1043560 |
| Address: | 3472 FOREST HILL BLVD,STE 2C, PALM SPRINGS, FL, 33406, US |
| Mail Address: | 3472 FOREST HILL BLVD,STE 2C, PALM SPRINGS, FL, 33406, US |
| ZIP code: | 33406 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1326399791 | 2012-09-26 | 2012-09-26 | 5215 COCONUT CREEK PKWY, MARGATE, FL, 330633916, US | 4801 S CONGRESS AVE, SUITE 304, LAKE WORTH, FL, 334614746, US | |||||||||||||
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| Phone | +1 954-586-8058 |
Authorized person
| Name | JOSEPH J DICAPUA |
| Role | MGMR |
| Phone | 5618437720 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| HINMAN ROY HMD | Agent | 100 ARRICOLA AVE, ST. AUGUSTINE, FL, 32080 |
| Name | Role | Address |
|---|---|---|
| BASSETT ROY MD | Managing Member | 3472 FOREST HILL BLVD,STE 2C, PALM SPRINGS, FL, 33406 |
| Name | Role | Address |
|---|---|---|
| George Sadowski MD PA | Manager | 2460 Gold Moultrie Road, St. Augustine, FL, 32086 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2016-01-12 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2015-04-14 | HINMAN, ROY H, MD | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2015-04-14 | 100 ARRICOLA AVE, ST. AUGUSTINE, FL 32080 | No data |
| LC AMENDMENT | 2014-04-07 | No data | No data |
| Name | Date |
|---|---|
| VOLUNTARY DISSOLUTION | 2016-01-12 |
| ANNUAL REPORT | 2015-04-14 |
| LC Amendment | 2014-04-07 |
| ANNUAL REPORT | 2014-01-10 |
| ANNUAL REPORT | 2013-04-29 |
| Florida Limited Liability | 2012-09-24 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
