| Entity Name: | INTERNAL MEDICINE INSTITUTE OF SOUTH FL LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 29 May 2014 (11 years ago) |
| Date of dissolution: | 25 Sep 2020 (4 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 25 Sep 2020 (4 years ago) |
| Document Number: | L14000086326 |
| FEI/EIN Number | 47-0997783 |
| Address: | 791 CHARLEMAGNE BLVD, NAPLES, FL, 34112, US |
| Mail Address: | 791 CHARLEMAGNE BLVD, NAPLES, FL, 34112, US |
| ZIP code: | 34112 |
| County: | Collier |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1770997447 | 2014-06-20 | 2014-06-20 | 4061 BONITA BEACH RD STE 101, BONITA SPRINGS, FL, 341344073, US | 12264 TAMIAMI TRL E STE 203, NAPLES, FL, 341137942, US | |||||||||||||||||||||||||||||||
|
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| Phone | +1 239-304-9071 |
| Fax | 2393049320 |
Authorized person
| Name | RODOLFO FREIRE |
| Role | MEDICAL DIRECTOR |
| Phone | 2393049071 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| License Number | ME109303 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BC& BS |
| Number | 14HA1 |
| State | FL |
| Issuer | MEDICAID |
| Number | 005826000 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| FREIRE RODOLFO | Agent | 791 CHARLEMAGNE BLVD, NAPLES, FL, 34112 |
| Name | Role | Address |
|---|---|---|
| FREIRE RODOLFO | Managing Member | 791 CHARLEMAGNE BLVD, NAPLES, FL, 34112 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2020-09-25 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2017-01-08 | 791 CHARLEMAGNE BLVD, NAPLES, FL 34112 | No data |
| CHANGE OF MAILING ADDRESS | 2017-01-08 | 791 CHARLEMAGNE BLVD, NAPLES, FL 34112 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2017-01-08 | 791 CHARLEMAGNE BLVD, NAPLES, FL 34112 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2019-01-23 |
| ANNUAL REPORT | 2018-04-18 |
| ANNUAL REPORT | 2017-01-08 |
| ANNUAL REPORT | 2016-01-06 |
| ANNUAL REPORT | 2015-03-23 |
| Florida Limited Liability | 2014-05-29 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
