| Entity Name: | EXTREME INFUSED MEDICAL PLUS, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 20 Jan 2022 (3 years ago) |
| Last Event: | LC DISSOCIATION MEM |
| Event Date Filed: | 22 Feb 2022 (3 years ago) |
| Document Number: | L22000040046 |
| FEI/EIN Number | 88-0791850 |
| Address: | 11871 Illinois Street, DUNNELLON, FL, 34431, US |
| Mail Address: | 11871 Illinois Street, DUNNELLON, FL, 34431, US |
| ZIP code: | 34431 |
| County: | Marion |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1457086654 | 2022-07-21 | 2024-03-14 | 11871 ILLINOIS ST, DUNNELLON, FL, 344316503, US | 11871 ILLINOIS ST, DUNNELLON, FL, 344316503, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 352-220-3873 |
| Fax | 3525177088 |
Authorized person
| Name | NIKALINA LELIEA DUNDAS |
| Role | OWNER PROVIDER |
| Phone | 3522203873 |
Taxonomy
| Taxonomy Code | 251F00000X - Home Infusion Agency |
| Is Primary | No |
| Taxonomy Code | 261QI0500X - Infusion Therapy Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 261QR1300X - Rural Health Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS |
| Number | HUR18 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| DUNDAS NIKALINA L | Agent | 8203 N NEIGE POINT, CRYSTAL RIVER, FL, 34428 |
| Name | Role | Address |
|---|---|---|
| Dundas Ryan J | Auth | 7630 W DUNNELLON ROAD, DUNNELLON, FL, 34433 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G23000082299 | COAST TO COAST FAMILY WELLNESS | ACTIVE | 2023-07-12 | 2028-12-31 | No data | 2818 W DUNNELLON ROAD, DUNNELLON, FL, 34433 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC DISSOCIATION MEM | 2022-02-22 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-08 |
| ANNUAL REPORT | 2023-01-24 |
| CORLCDSMEM | 2022-02-22 |
| Florida Limited Liability | 2022-01-20 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
