| Entity Name: | BAYCARE OUTPATIENT IMAGING, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 02 Oct 2018 (6 years ago) |
| Document Number: | L18000233722 |
| FEI/EIN Number | 832149743 |
| Address: | 2985 DREW STREET, CLEARWATER, FL, 33759, US |
| Mail Address: | 2985 DREW STREET, CLEARWATER, FL, 33759, US |
| ZIP code: | 33759 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1568202133 | 2024-05-30 | 2024-05-30 | 2995 DREW ST FL 2, CLEARWATER, FL, 337593012, US | 3198 N. PARK ROAD, SUITE 102, PLANT CITY, FL, 33563, US | |||||||||||||||||||||||||
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| Phone | +1 727-315-6974 |
| Fax | 8136352613 |
| Phone | +1 813-757-1204 |
| Fax | 8137571212 |
Authorized person
| Name | LYNDA GORKEN |
| Role | VICE PRESIDENT |
| Phone | 7272819202 |
Taxonomy
| Taxonomy Code | 2085R0202X - Diagnostic Radiology Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 101818505 |
| State | FL |
| Name | Role |
|---|---|
| BAYCARE HEALTH SYSTEM, INC. | Agent |
| Name | Role |
|---|---|
| BAYCARE HEALTH SYSTEM, INC. | Authorized Member |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2024-01-23 | BAYCARE HEALTH SYSTEM, INC. | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-23 |
| ANNUAL REPORT | 2023-02-07 |
| ANNUAL REPORT | 2022-01-26 |
| ANNUAL REPORT | 2021-02-10 |
| ANNUAL REPORT | 2020-04-17 |
| ANNUAL REPORT | 2019-03-19 |
| Florida Limited Liability | 2018-10-02 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
