| Entity Name: | TAMPA BAY DIAGNOSTIC INSTITUTE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 17 Aug 2021 (3 years ago) |
| Document Number: | L21000369573 |
| FEI/EIN Number | 87-2223993 |
| Address: | 106 N Evers St., PLANT CITY, FL 33563 |
| Mail Address: | 1601 REYNOLDS ST, 203, PLANT CITY, FL 33563 |
| ZIP code: | 33563 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1316614175 | 2021-08-27 | 2024-08-06 | 4085 HEMLOCK LN, TITUSVILLE, FL, 327802822, US | 106 N EVERS ST, PLANT CITY, FL, 335633330, US | |||||||||||||||||||
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| Phone | +1 813-763-5607 |
Authorized person
| Name | MATTHEW B CHANDLER |
| Role | OWNER |
| Phone | 2127346621 |
Taxonomy
| Taxonomy Code | 291U00000X - Clinical Medical Laboratory |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | COLA |
| Number | 31315 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| abraham rosenberg | Agent | 106 north evers, PLANT CITY, FL 33563 |
| Name | Role | Address |
|---|---|---|
| Chandler, Matthew | Manage | 4085 Hemlock Lane, Titusville, FL 32780 |
| Name | Role | Address |
|---|---|---|
| Rosenberg, Abraham | Manager | 1068 48th Street, Brooklyn, NY 11219 |
| Gruenstein, Yehudah | Manager | 16 Monroe Place, New York, NY 10314 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-10-11 | 106 N Evers St., PLANT CITY, FL 33563 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-31 |
| ANNUAL REPORT | 2023-03-02 |
| AMENDED ANNUAL REPORT | 2022-06-20 |
| ANNUAL REPORT | 2022-01-29 |
| Florida Limited Liability | 2021-08-17 |
Date of last update: 13 Feb 2025
Sources: Florida Department of State
