| Entity Name: | PETERSON ACUPUNCTURE CENTER, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 23 Feb 2017 (8 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 13 Dec 2024 (2 months ago) |
| Document Number: | L17000043226 |
| FEI/EIN Number | 82-0714168 |
| Address: | 4303 Canna-Lily Drive, NEW PORT RICHEY, FL, 34652, US |
| Mail Address: | 5135 Y=US Hwy 19 N, NEW PORT RICHEY, FL, 34652, US |
| ZIP code: | 34652 |
| County: | Pasco |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1386174951 | 2017-06-15 | 2022-07-21 | 12100 COBBLESTONE DR STE 3, BAYONET POINT, FL, 346672487, US | 12100 COBBLESTONE DR STE 3, BAYONET POINT, FL, 346672487, US | |||||||||||||||||||||||
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| Phone | +1 727-378-7469 |
Authorized person
| Name | DR. W JOSEPH PETERSON |
| Role | OWNER |
| Phone | 7273787469 |
Taxonomy
| Taxonomy Code | 261Q00000X - Clinic/Center |
| License Number | AP1568 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1528024072 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| PETERSON W JOSEPH Dr. | Agent | 4303 Canna-Lily Drive, NEW PORT RICHEY, FL, 34652 |
| Name | Role | Address |
|---|---|---|
| PETERSON W JOSEPH DR | Director | 4303 Canna-Lily Drive, NEW PORT RICHEY, FL, 34652 |
| Name | Role | Address |
|---|---|---|
| PETERSON W JOSEPH DR | Officer | 4303 Canna-Lily Drive, NEW PORT RICHEY, FL, 34652 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2024-12-13 | 4303 Canna-Lily Drive, NEW PORT RICHEY, FL 34652 | No data |
| REINSTATEMENT | 2024-12-13 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2024-12-13 | 4303 Canna-Lily Drive, NEW PORT RICHEY, FL 34652 | No data |
| CHANGE OF MAILING ADDRESS | 2024-12-13 | 4303 Canna-Lily Drive, NEW PORT RICHEY, FL 34652 | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2024-09-27 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2018-10-22 | PETERSON, W JOSEPH, Dr. | No data |
| REINSTATEMENT | 2018-10-22 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2018-09-28 | No data | No data |
| Name | Date |
|---|---|
| REINSTATEMENT | 2024-12-13 |
| ANNUAL REPORT | 2023-04-06 |
| ANNUAL REPORT | 2022-02-16 |
| ANNUAL REPORT | 2021-03-23 |
| ANNUAL REPORT | 2020-03-16 |
| ANNUAL REPORT | 2019-01-11 |
| REINSTATEMENT | 2018-10-22 |
| Florida Limited Liability | 2017-02-23 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
