| Entity Name: | AMERICAN VITALITY MEDICAL GROUP, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 24 Jun 2020 (5 years ago) |
| Document Number: | L20000179540 |
| FEI/EIN Number | 85-1963380 |
| Address: | 4120 Corley Island Road, leesburg, FL, 34748, US |
| Mail Address: | 1100 LAKE DORA DRIVE, TAVARES, FL, 32778 |
| ZIP code: | 34748 |
| County: | Lake |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1649026428 | 2024-04-24 | 2024-04-24 | 1100 LAKE DORA DR, TAVARES, FL, 327783529, US | 4120 CORLEY ISLAND RD STE 500, LEESBURG, FL, 347488297, US | |||||||||||||||||
|
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| Phone | +1 727-415-7253 |
Authorized person
| Name | MR. DOUGLAS RODANTE |
| Role | PRESIDENT |
| Phone | 7274157253 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 261QM1300X - Multi-Specialty Clinic/Center |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| DOUGLAS RODANTE | Agent | 1100 LAKE DORA DRIVE, TAVARES, FL, 32778 |
| Name | Role | Address |
|---|---|---|
| RODANTE DOUGLAS | President | 1100 LAKE DORA DRIVE, TAVARES, FL, 32778 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-04-08 | 4120 Corley Island Road, #500, leesburg, FL 34748 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-08 |
| ANNUAL REPORT | 2023-04-21 |
| ANNUAL REPORT | 2022-04-21 |
| ANNUAL REPORT | 2021-04-08 |
| Florida Limited Liability | 2020-06-24 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
