| Entity Name: | IMPACT MEDICAL GROUP, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 29 May 2018 (7 years ago) |
| Last Event: | LC NAME CHANGE |
| Event Date Filed: | 14 Apr 2021 (4 years ago) |
| Document Number: | L18000133845 |
| FEI/EIN Number | 83-0861721 |
| Address: | 2701 Park Drive, Suite 2 & 7, Clearwater, FL 33763 |
| Mail Address: | 990 31st Ave NE, St Petersburg, FL 33704 |
| ZIP code: | 33763 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1992263164 | 2019-03-06 | 2022-02-28 | PO BOX 7982, SEMINOLE, FL, 337757982, US | 2014 ASHLEY OAKS CIR, WESLEY CHAPEL, FL, 335446400, US | |||||||||||||||||||||
|
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| Phone | +1 813-953-1002 |
Authorized person
| Name | MELISSA N BOTBYL |
| Role | ADMINISTRATOR |
| Phone | 7272724919 |
Taxonomy
| Taxonomy Code | 111N00000X - Chiropractor |
| Is Primary | Yes |
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 261QP2000X - Physical Therapy Clinic/Center |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| Wolstein, Julie | Agent | 990 31st Ave NE, St Petersburg, FL 33704 |
| Name | Role | Address |
|---|---|---|
| WOLSTEIN, BRIAN | Manager | 990 31ST AVE NE, SAINT PETERSBURG, FL 33704 |
| WOLSTEIN, JULIE | Manager | 990 31ST AVE NE, SAINT PETERSBURG, FL 33704 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G23000083810 | IMPACT MUA | ACTIVE | 2023-07-17 | 2028-12-31 | No data | 2701 PARK DRIVE, SUITE 2 & 7, CLEARWATER, FL, 33704 |
| G23000083813 | IMPACT TRAUMA COUNSELING | ACTIVE | 2023-07-17 | 2028-12-31 | No data | 2701 PARK DRIVE, SUITE 2 & 7, CLEARWATER, FL, 33704 |
| G23000083816 | IMPACT REJUVENATION | ACTIVE | 2023-07-17 | 2028-12-31 | No data | 2701 PARK DRIVE, SUITE 2 & 7, CLEARWATER, FL, 33704 |
| G23000083817 | IMPACT SURGICAL CONSULTANTS | ACTIVE | 2023-07-17 | 2028-12-31 | No data | 2701 PARK DRIVE, SUITE 2 & 7, CLEARWATER, FL, 33704 |
| G21000074693 | TOTAL VITALITY MEDICAL | ACTIVE | 2021-06-03 | 2026-12-31 | No data | 2014 ASHLEY OAKS CIRCLE, SUITE 101 & 102, WESLEY CHAPEL, FL, 33544 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-03-07 | 2701 Park Drive, Suite 2 & 7, Clearwater, FL 33763 | No data |
| CHANGE OF MAILING ADDRESS | 2024-03-07 | 2701 Park Drive, Suite 2 & 7, Clearwater, FL 33763 | No data |
| REGISTERED AGENT NAME CHANGED | 2024-03-07 | Wolstein, Julie | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-03-07 | 990 31st Ave NE, St Petersburg, FL 33704 | No data |
| LC NAME CHANGE | 2021-04-14 | IMPACT MEDICAL GROUP, LLC | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-07 |
| ANNUAL REPORT | 2023-01-17 |
| ANNUAL REPORT | 2022-01-31 |
| LC Name Change | 2021-04-14 |
| ANNUAL REPORT | 2021-03-15 |
| ANNUAL REPORT | 2020-01-14 |
| ANNUAL REPORT | 2019-04-30 |
| Florida Limited Liability | 2018-05-29 |
Date of last update: 18 Jan 2025
Sources: Florida Department of State
