| Entity Name: | CLOVER EMERGENCY PHYSICIANS, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 22 Oct 2013 (11 years ago) |
| Date of dissolution: | 31 May 2024 (8 months ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 31 May 2024 (8 months ago) |
| Document Number: | L13000149259 |
| FEI/EIN Number | 75-2758837 |
| Address: | 20 Burton Hills Blvd, Suite 500, NASHVILLE, TN, 37215, US |
| Mail Address: | 20 Burton Hills Blvd, Suite 500, NASHVILLE, TN, 37215, US |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1891744736 | 2006-05-08 | 2013-12-22 | 13737 NOEL RD, DALLAS, TX, 752401331, US | 2323 9TH AVE N, ST PETERSBURG, FL, 337136832, US | |||||||||||||||||||||||||||||
|
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| Phone | +1 469-401-2386 |
| Fax | 2147122444 |
| Phone | +1 727-326-6185 |
Authorized person
| Name | DR. TERRY R MEADOWS |
| Role | VICE PRESIDENT |
| Phone | 4694012386 |
Taxonomy
| Taxonomy Code | 207P00000X - Emergency Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE SHIELD |
| Number | 21794 |
| State | FL |
| Issuer | MEDICAID |
| Number | 254689200 |
| State | FL |
| Name | Role |
|---|---|
| CORPORATION SERVICE COMPANY | Agent |
| Name | Role | Address |
|---|---|---|
| BYRNE GREGORY JMD | Manager | 20 Burton Hills Blvd, NASHVILLE, TN, 37215 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2024-05-31 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2024-04-22 | 20 Burton Hills Blvd, Suite 500, NASHVILLE, TN 37215 | No data |
| CHANGE OF MAILING ADDRESS | 2024-04-22 | 20 Burton Hills Blvd, Suite 500, NASHVILLE, TN 37215 | No data |
| CONVERSION | 2013-10-22 | No data | GEN-COR CONVERSION RESULT. THE CONVERTING ENTITY WAS GP1300001484 ORIGINALLY FILED ON 10/21/2013. CONVERSION NUMBER 300000135383 |
| Name | Date |
|---|---|
| VOLUNTARY DISSOLUTION | 2024-05-31 |
| ANNUAL REPORT | 2024-04-22 |
| ANNUAL REPORT | 2023-04-23 |
| ANNUAL REPORT | 2022-04-27 |
| ANNUAL REPORT | 2021-04-24 |
| ANNUAL REPORT | 2020-06-15 |
| ANNUAL REPORT | 2019-04-17 |
| ANNUAL REPORT | 2018-04-20 |
| ANNUAL REPORT | 2017-04-20 |
| ANNUAL REPORT | 2016-04-26 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
