| Entity Name: | MRI ASSOCIATES OF BRADENTON LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 19 Nov 2015 (9 years ago) |
| Last Event: | LC STMNT OF RA/RO CHG |
| Event Date Filed: | 19 Dec 2023 (a year ago) |
| Document Number: | L15000195788 |
| FEI/EIN Number | 81-1128070 |
| Address: | 5817 B 21st Avenue W, Bradenton, FL, 34209, US |
| Mail Address: | 5817 B 21st Avenue W, Bradenton, FL, 34209, US |
| ZIP code: | 34209 |
| County: | Manatee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1497117055 | 2016-03-23 | 2023-07-17 | 5817 21ST AVE W, BRADENTON, FL, 342095641, US | 5817 21ST AVE W, BRADENTON, FL, 342095641, US | |||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||
| Phone | +1 941-567-4039 |
| Fax | 9415674041 |
Authorized person
| Name | AMANDA MAPLE |
| Role | CAO |
| Phone | 7277876900 |
Taxonomy
| Taxonomy Code | 2085R0202X - Diagnostic Radiology Physician |
| Is Primary | No |
| Taxonomy Code | 261QR0200X - Radiology Clinic/Center |
| License Number | HCC8214 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 114332800 |
| State | FL |
| Issuer | BCBS |
| Number | I059K |
| State | FL |
| Name | Role |
|---|---|
| CORPORATION SERVICE COMPANY | Agent |
| Name | Role | Address |
|---|---|---|
| GREGORY DAVID S | Chief Executive Officer | 32615 US Highway N, PALM HARBOR, FL, 34684 |
| DIECIDUE FRANK J | Chief Executive Officer | 32615 US Highway N, PALM HARBOR, FL, 34684 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G16000001677 | BRADENTON MRI | ACTIVE | 2016-01-05 | 2027-12-31 | No data | 32615 US HWY 19 N STE 4, PALM HARBOR, FL, 34684 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-04-17 | 5817 B 21st Avenue W, Bradenton, FL 34209 | No data |
| CHANGE OF MAILING ADDRESS | 2024-04-17 | 5817 B 21st Avenue W, Bradenton, FL 34209 | No data |
| LC STMNT OF RA/RO CHG | 2023-12-19 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2023-12-19 | CORPORATION SERVICE COMPANY | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-12-19 | 1201 HAYS STREET, TALLAHASSEE, FL 32301-2525 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-17 |
| CORLCRACHG | 2023-12-19 |
| ANNUAL REPORT | 2023-01-28 |
| ANNUAL REPORT | 2022-04-06 |
| ANNUAL REPORT | 2021-01-04 |
| ANNUAL REPORT | 2020-01-29 |
| ANNUAL REPORT | 2019-03-01 |
| ANNUAL REPORT | 2018-01-08 |
| ANNUAL REPORT | 2017-01-21 |
| AMENDED ANNUAL REPORT | 2016-08-03 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
