| Entity Name: | C12 MEDICAL, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 20 Jun 2016 (9 years ago) |
| Date of dissolution: | 23 Sep 2022 (2 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 23 Sep 2022 (2 years ago) |
| Document Number: | L16000120657 |
| FEI/EIN Number | 81-2899350 |
| Address: | 8498 108TH WAY, SEMINOLE, FL, 33772, US |
| Mail Address: | 8498 108TH WAY, SEMINOLE, FL, 33772, US |
| ZIP code: | 33772 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1972071801 | 2018-11-08 | 2018-11-08 | 8498 108TH WAY, SEMINOLE, FL, 337724318, US | 333 16TH AVE SE, LARGO, FL, 337714407, US | |||||||||||||||||||
|
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| Phone | +1 727-251-7782 |
Authorized person
| Name | CHRISTIAN S CHILDERS |
| Role | OT |
| Phone | 7272517782 |
Taxonomy
| Taxonomy Code | 225X00000X - Occupational Therapist |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | STATE LICENSE |
| Number | OT10920 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CHILDERS CHRISTIAN | Agent | 8498 108TH WAY, SEMINOLE, FL, 33772 |
| Name | Role | Address |
|---|---|---|
| CHILDERS CHRISTIAN | Authorized Member | 8498 108TH WAY, SEMINOLE, FL, 33772 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2025-10-08 | 8498 108TH WAY, SEMINOLE, FL 33772 | No data |
| CHANGE OF MAILING ADDRESS | 2025-10-08 | 8498 108TH WAY, SEMINOLE, FL 33772 | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2022-09-23 | No data | No data |
| REINSTATEMENT | 2021-10-05 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2021-10-05 | CHILDERS, CHRISTIAN | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2021-09-24 | No data | No data |
| Name | Date |
|---|---|
| REINSTATEMENT | 2021-10-05 |
| ANNUAL REPORT | 2020-06-09 |
| ANNUAL REPORT | 2019-04-25 |
| ANNUAL REPORT | 2018-05-01 |
| ANNUAL REPORT | 2017-05-01 |
| Florida Limited Liability | 2016-06-20 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
