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IMPACT MEDICAL GROUP, LLC - Florida Company Profile

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Company Details

Entity Name: IMPACT MEDICAL GROUP, LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
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, Clearwater, FL, 33763, US
Mail Address: 990 31st Ave NE, St Petersburg, FL, 33704, US
ZIP code: 33763
City: Clearwater
County: Pinellas
Place of Formation: FLORIDA

Key Officers & Management

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
Wolstein Julie Agent 990 31st Ave NE, St Petersburg, FL, 33704

National Provider Identifier

NPI Number:
1992263164
Certification Date:
2022-02-28

Authorized Person:

Name:
MELISSA N BOTBYL
Role:
ADMINISTRATOR
Phone:

Taxonomy:

Selected Taxonomy:
207Q00000X - Family Medicine Physician
Is Primary:
No
Selected Taxonomy:
261QP2000X - Physical Therapy Clinic/Center
Is Primary:
No
Selected Taxonomy:
111N00000X - Chiropractor
Is Primary:
Yes

Contacts:

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G23000083810 IMPACT MUA ACTIVE 2023-07-17 2028-12-31 - 2701 PARK DRIVE, SUITE 2 & 7, CLEARWATER, FL, 33704
G23000083813 IMPACT TRAUMA COUNSELING ACTIVE 2023-07-17 2028-12-31 - 2701 PARK DRIVE, SUITE 2 & 7, CLEARWATER, FL, 33704
G23000083816 IMPACT REJUVENATION ACTIVE 2023-07-17 2028-12-31 - 2701 PARK DRIVE, SUITE 2 & 7, CLEARWATER, FL, 33704
G23000083817 IMPACT SURGICAL CONSULTANTS ACTIVE 2023-07-17 2028-12-31 - 2701 PARK DRIVE, SUITE 2 & 7, CLEARWATER, FL, 33704
G21000074693 TOTAL VITALITY MEDICAL ACTIVE 2021-06-03 2026-12-31 - 2014 ASHLEY OAKS CIRCLE, SUITE 101 & 102, WESLEY CHAPEL, FL, 33544

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2024-03-07 2701 Park Drive, Suite 2 & 7, Clearwater, FL 33763 -
CHANGE OF MAILING ADDRESS 2024-03-07 2701 Park Drive, Suite 2 & 7, Clearwater, FL 33763 -
REGISTERED AGENT NAME CHANGED 2024-03-07 Wolstein, Julie -
REGISTERED AGENT ADDRESS CHANGED 2024-03-07 990 31st Ave NE, St Petersburg, FL 33704 -
LC NAME CHANGE 2021-04-14 IMPACT MEDICAL GROUP, LLC -

Documents

Name Date
ANNUAL REPORT 2025-01-31
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

Trademarks

Serial Number:
90693309
Mark:
IMPACT MEDICAL GROUP
Status:
Registered. The registration date is used to determine when post-registration maintenance documents are due.
Mark Type:
Service Mark
Application Filing Date:
2021-05-06
Mark Drawing Type:
3 - AN ILLUSTRATION DRAWING WHICH INCLUDES WORD(S)/ LETTER(S) /NUMBER(S)
Mark Literal Elements:
IMPACT MEDICAL GROUP

Goods And Services

For:
Chiropractic services; Medical clinic services
First Use:
2021-07-01
International Classes:
044 - Primary Class
Class Status:
ACTIVE

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Date of last update: 02 Aug 2025

Sources: Florida Department of State