| Entity Name: | DAYTONA MRI LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 30 Jun 2015 (10 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: | L15000113045 |
| FEI/EIN Number | 47-4442814 |
| Address: | 125 MASON AVE, DAYTONA BEACH, FL, 32117 |
| Mail Address: | 125 MASON AVE, DAYTONA BEACH, FL, 32117 |
| ZIP code: | 32117 |
| County: | Volusia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1316309800 | 2016-03-23 | 2017-05-31 | 125 MASON AVE, DAYTONA BEACH, FL, 321175017, US | 125 MASON AVE, DAYTONA BEACH, FL, 321175017, US | |||||||||||||||||||||||||||||
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| Phone | +1 386-463-4444 |
| Fax | 3863130304 |
Authorized person
| Name | DR. JOHNATHAN LIVINGSTON WAGNER |
| Role | OWNER |
| Phone | 3864634444 |
Taxonomy
| Taxonomy Code | 2471C3402X - Radiography Radiologic Technologist |
| Is Primary | No |
| Taxonomy Code | 2471M1202X - Magnetic Resonance Imaging Radiologic Technologist |
| Is Primary | No |
| Taxonomy Code | 293D00000X - Physiological Laboratory |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | NPI TYPE 1 |
| Number | 1881628220 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| LOGUIDICE JOSEPH A | Agent | 1515A RIDGEWOOD AVE, HOLLY HILL, FL, 32117 |
| Name | Role | Address |
|---|---|---|
| WAGNER JOHN | Manager | 125 MASON AVENUE, DAYTONA BEACH, FL, 32117 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2020-09-25 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2019-01-10 |
| ANNUAL REPORT | 2018-04-10 |
| ANNUAL REPORT | 2017-02-15 |
| ANNUAL REPORT | 2016-04-14 |
| Florida Limited Liability | 2015-06-30 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
