| Entity Name: | FM MEDICAL CLINIC, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 20 Feb 2018 (7 years ago) |
| Date of dissolution: | 17 Jan 2020 (5 years ago) |
| Last Event: | LC VOLUNTARY DISSOLUTION |
| Event Date Filed: | 17 Jan 2020 (5 years ago) |
| Document Number: | L18000045488 |
| FEI/EIN Number | 82-4509816 |
| Address: | 165 SOUTHPARK BLVD, ST AUGUSTINE, FL, 32086, US |
| Mail Address: | 165 SOUTHPARK BLVD, ST AUGUSTINE, FL, 32086, US |
| ZIP code: | 32086 |
| County: | St. Johns |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1891298790 | 2018-03-16 | 2018-03-17 | 165 SOUTHPARK BLVD, ST AUGUSTINE, FL, 320864101, US | 165 SOUTHPARK BLVD, ST AUGUSTINE, FL, 320864101, US | |||||||||||||||||||||
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| Phone | +1 904-823-8833 |
| Fax | 9048239394 |
Authorized person
| Name | DR. SCOTT R MICHAELS |
| Role | CLINIC DIRECTOR |
| Phone | 9048238833 |
Taxonomy
| Taxonomy Code | 261Q00000X - Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | DRIVERS LICENSES |
| Number | M242796603210 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MICHAELS SCOTT MD | Agent | 165 SOUTHPARK BLVD, ST AUGUSTINE, FL, 32086 |
| Name | Role | Address |
|---|---|---|
| MICHAELS SCOTT MD | Director | 165 SOUTHPARK BLVD, ST AUGUSTINE, FL, 32086 |
| FECHTER SCOTT DC | Director | 165 SOUTHPARK BLVD, ST AUGUSTINE, FL, 32086 |
| Name | Role | Address |
|---|---|---|
| MICHAELS SCOTT MD | Manager | 165 SOUTHPARK BLVD, ST AUGUSTINE, FL, 32086 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC VOLUNTARY DISSOLUTION | 2020-01-17 | No data | No data |
| Name | Date |
|---|---|
| LC Voluntary Dissolution | 2020-01-17 |
| ANNUAL REPORT | 2019-02-19 |
| Florida Limited Liability | 2018-02-20 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
