| Entity Name: | FOUNDATIONS MEDICAL CENTER, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 19 Sep 2014 (10 years ago) |
| Last Event: | LC NAME CHANGE |
| Event Date Filed: | 27 Oct 2014 (10 years ago) |
| Document Number: | L14000147110 |
| FEI/EIN Number | 47-2256578 |
| Address: | 4467 Commons Drive W., Suite F-G, Destin, FL 32541 |
| Mail Address: | 4467 Commons Drive W., Suite F-G, Destin, FL 32541 |
| ZIP code: | 32541 |
| County: | Okaloosa |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1811598105 | 2020-11-04 | 2020-11-04 | 4467 COMMONS DR W STE F-G, DESTIN, FL, 325418454, US | 4467 COMMONS DR W STE F-G, DESTIN, FL, 325418454, US | |||||||||||||||||||
|
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| Phone | +1 850-269-9000 |
| Fax | 8502699002 |
Authorized person
| Name | KYLE S CHAVERS |
| Role | OWNER |
| Phone | 8502699000 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
| Taxonomy Code | 207QA0505X - Adult Medicine Physician |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| CHAVERS, KYLE | Agent | 4467 Commons Drive W., Suite F-G, Destin, FL 32541 |
| Name | Role | Address |
|---|---|---|
| CHAVERS, KYLE | Manager | 4467 Commons Drive W., Suite F-G Destin, FL 32541 |
| Chavers, Amanda | Manager | 4467 Commons Drive W., Suite F-G Destin, FL 32541 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2017-05-08 | 4467 Commons Drive W., Suite F-G, Destin, FL 32541 | No data |
| CHANGE OF MAILING ADDRESS | 2017-05-08 | 4467 Commons Drive W., Suite F-G, Destin, FL 32541 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2017-05-08 | 4467 Commons Drive W., Suite F-G, Destin, FL 32541 | No data |
| LC NAME CHANGE | 2014-10-27 | FOUNDATIONS MEDICAL CENTER, PLLC | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-03 |
| ANNUAL REPORT | 2024-02-12 |
| ANNUAL REPORT | 2023-02-02 |
| ANNUAL REPORT | 2022-02-23 |
| ANNUAL REPORT | 2021-02-01 |
| ANNUAL REPORT | 2020-01-21 |
| ANNUAL REPORT | 2019-06-10 |
| ANNUAL REPORT | 2018-04-16 |
| ANNUAL REPORT | 2017-05-08 |
| ANNUAL REPORT | 2016-04-25 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 3269588410 | 2021-02-04 | 0491 | PPS | 4467 Commons Dr W Ste F-G, Destin, FL, 32541-8454 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 6577467005 | 2020-04-07 | 0491 | PPP | 4467 COMMONS DR. W. STE F-G, DESTIN, FL, 32541-8455 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 20 Feb 2025
Sources: Florida Department of State
