| Entity Name: | MARY MONTSKO, MD LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 30 May 2013 (12 years ago) |
| Date of dissolution: | 23 Feb 2018 (7 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 23 Feb 2018 (7 years ago) |
| Document Number: | L13000078275 |
| FEI/EIN Number | 46-3036351 |
| Address: | 16750 IVY LAKE ROAD, ODESSA, FL, 33556, US |
| Mail Address: | 16750 IVY LAKE ROAD, ODESSA, FL, 33556, US |
| ZIP code: | 33556 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1760824429 | 2013-07-23 | 2013-07-23 | 2727 W DR MARTIN LUTHER KING JR BLVD, SUITE 800, TAMPA, FL, 336076383, US | 2727 W DR MARTIN LUTHER KING JR BLVD, SUITE 800, TAMPA, FL, 336076383, US | |||||||||||||||||||||
|
|||||||||||||||||||||||||
| Phone | +1 813-931-3124 |
| Fax | 8132651717 |
Authorized person
| Name | MARY MONTSKO |
| Role | PRESIDENT |
| Phone | 8139633124 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 276829100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MONTSKO MARY C | Agent | 16750 IVY LAKE ROAD, ODESSA, FL, 33556 |
| Name | Role | Address |
|---|---|---|
| MONTSKO MARY CMD | Managing Member | 16750 IVY LAKE ROAD, ODESSA, FL, 33556 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2018-02-23 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2017-04-10 |
| ANNUAL REPORT | 2016-04-28 |
| ANNUAL REPORT | 2015-04-27 |
| ANNUAL REPORT | 2014-04-22 |
| Florida Limited Liability | 2013-05-30 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
