| Entity Name: | JACK M MATHENY II MD, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 04 Jan 2019 (6 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 06 May 2019 (6 years ago) |
| Document Number: | L19000007168 |
| FEI/EIN Number | 83-3133859 |
| Mail Address: | PO BOX 330196, ATLANTIC BEACH, FL 32233 |
| Address: | 700 ZEAGLER DRIVE, SUITE 10, PALATKA, FL 32177 |
| ZIP code: | 32177 |
| County: | Putnam |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1578399747 | 2024-09-12 | 2024-09-15 | PO BOX 330196, ATLANTIC BEACH, FL, 322330196, US | 700 ZEAGLER DR STE 10, PALATKA, FL, 321773826, US | |||||||||||||||||||||
|
|||||||||||||||||||||||||
| Phone | +1 386-328-6746 |
Authorized person
| Name | DR. SATISH V RAVI |
| Role | DIRECTOR |
| Phone | 3863286746 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 261QR1300X - Rural Health Clinic/Center |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| RAVI, SATISH | Agent | 700 ZEAGLER DRIVE, SUITE 10, PALATKA, FL 32177 |
| Name | Role |
|---|---|
| FIRST COAST BETTER HEALTH AND WELLNESS GROUP, LLC | Authorized Member |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G24000063642 | BETTER HEALTH AND WELLNESS CLINIC | ACTIVE | 2024-05-16 | 2029-12-31 | No data | PO BOX 330196, ATLANTIC BEACH, FL, 32233 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2024-05-16 | 700 ZEAGLER DRIVE, SUITE 10, PALATKA, FL 32177 | No data |
| REGISTERED AGENT NAME CHANGED | 2024-05-16 | RAVI, SATISH | No data |
| LC AMENDMENT | 2019-05-06 | No data | No data |
| Name | Date |
|---|---|
| AMENDED ANNUAL REPORT | 2024-05-16 |
| ANNUAL REPORT | 2024-04-16 |
| ANNUAL REPORT | 2023-03-16 |
| ANNUAL REPORT | 2022-04-10 |
| ANNUAL REPORT | 2021-04-12 |
| ANNUAL REPORT | 2020-01-31 |
| LC Amendment | 2019-05-06 |
| Florida Limited Liability | 2019-01-04 |
Date of last update: 17 Jan 2025
Sources: Florida Department of State
