| Entity Name: | EAST LAKE MEDICAL CLINIC, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Inactive |
| Date Filed: | 12 Apr 2013 (12 years ago) |
| Date of dissolution: | 02 Mar 2016 (9 years ago) |
| Last Event: | CONVERSION |
| Event Date Filed: | 02 Mar 2016 (9 years ago) |
| Document Number: | L13000053766 |
| FEI/EIN Number | 46-2478545 |
| Address: | 4737 OLD CANOE CREEK ROAD, ST. CLOUD, FL 34769 |
| Mail Address: | 4737 old canoe creek rd, ST. CLOUD, FL 34769 |
| ZIP code: | 34769 |
| County: | Osceola |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1790124741 | 2013-06-21 | 2013-06-21 | 4737 OLD CANOE CREEK RD, SAINT CLOUD, FL, 347691400, US | 4737 OLD CANOE CREEK RD, SAINT CLOUD, FL, 347691400, US | |||||||||||||||||
|
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| Phone | +1 407-705-3222 |
Authorized person
| Name | DR. DUSTIN LY |
| Role | PRESIDENT |
| Phone | 4077053222 |
Taxonomy
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| License Number | ME114777 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| LY, KATE N | Agent | 4737 old canoe creek rd, ST. CLOUD, FL 34769 |
| Name | Role | Address |
|---|---|---|
| LY, KATE N | Manager | 4737 OLD CANOE CREEK RD, ST. CLOUD, FL 34769 |
| Name | Role | Address |
|---|---|---|
| LY, DUSTIN N | Managing Member | 4737 OLD CANOE CREEK RD, ST. CLOUD, FL 34769 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CONVERSION | 2016-03-02 | No data | CONVERSION MEMBER. RESULTING CORPORATION WAS P16000021885. CONVERSION NUMBER 100000158991 |
| CHANGE OF MAILING ADDRESS | 2014-01-09 | 4737 OLD CANOE CREEK ROAD, ST. CLOUD, FL 34769 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2014-01-09 | 4737 old canoe creek rd, ST. CLOUD, FL 34769 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2016-01-27 |
| ANNUAL REPORT | 2015-01-07 |
| ANNUAL REPORT | 2014-01-09 |
| Florida Limited Liability | 2013-04-12 |
Date of last update: 22 Jan 2025
Sources: Florida Department of State
