| Entity Name: | WATKINS FOOT AND ANKLE CLINIC, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 07 Nov 2016 (8 years ago) |
| Last Event: | CORPORATE MERGER |
| Event Date Filed: | 16 May 2018 (7 years ago) |
| Document Number: | L16000204758 |
| FEI/EIN Number | 81-4372381 |
| Address: | 914 EAST DIXIE AVE., LEESBURG, FL, 34748, US |
| Mail Address: | 914 EAST DIXIE AVE., LEESBURG, FL, 34748, US |
| ZIP code: | 34748 |
| County: | Lake |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1982146346 | 2016-11-16 | 2018-10-01 | 914 E DIXIE AVE, LEESBURG, FL, 347487647, US | 914 E DIXIE AVE, LEESBURG, FL, 347487647, US | |||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||
| Phone | +1 352-805-4317 |
| Fax | 3528054298 |
Authorized person
| Name | DR. CHAD C WATKINS |
| Role | CEO |
| Phone | 3528054317 |
Taxonomy
| Taxonomy Code | 213ES0103X - Foot & Ankle Surgery Podiatrist |
| License Number | PO2769 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 390469500 |
| State | FL |
| Issuer | NPI |
| Number | 1174514194 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| WATKINS CHAD | Agent | 914 EAST DIXIE AVE., LEESBURG, FL, 34748 |
| Name | Role | Address |
|---|---|---|
| WATKINS CHAD | Authorized Member | 914 EAST DIXIE AVE., LEESBURG, FL, 34748 |
| Name | Role | Address |
|---|---|---|
| WATKINS NATALIE | Manager | 914 EAST DIXIE AVE., LEESBURG, FL, 34748 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| MERGER | 2018-05-16 | No data | CORPORATION WAS A MERGER RESULT. TOTAL NUMBER OF QUALIFIED CORPORATION(S) INVOLVED WAS 1. MERGER NUMBER 100000181971 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-29 |
| ANNUAL REPORT | 2023-03-20 |
| ANNUAL REPORT | 2022-02-17 |
| ANNUAL REPORT | 2021-02-01 |
| ANNUAL REPORT | 2020-02-06 |
| ANNUAL REPORT | 2019-04-01 |
| Merger | 2018-05-16 |
| ANNUAL REPORT | 2018-01-13 |
| ANNUAL REPORT | 2017-01-11 |
| Florida Limited Liability | 2016-11-07 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
