| Entity Name: | THE WAY MEDICAL GROUP LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Inactive |
| Date Filed: | 30 Aug 2022 (2 years ago) |
| Date of dissolution: | 02 Oct 2023 (a year ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 02 Oct 2023 (a year ago) |
| Document Number: | L22000381759 |
| FEI/EIN Number | 88-3756227 |
| Address: | 1030 VENETIAN DR, UNITE 202, MELBOURNE, FL 32904 |
| Mail Address: | 1030 VENETIAN WAY, UNITE 202, MELBOURNE, FL 32904 |
| ZIP code: | 32904 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1386365476 | 2022-09-07 | 2023-07-26 | 4780 DAIRY RD, MELBOURNE, FL, 329048482, US | 4780 DAIRY RD, MELBOURNE, FL, 329048482, US | |||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 321-989-2187 |
Authorized person
| Name | DR. JAY BOULDIN |
| Role | CEO |
| Phone | 3219892187 |
Taxonomy
| Taxonomy Code | 207QA0505X - Adult Medicine Physician |
| Is Primary | Yes |
| Taxonomy Code | 208D00000X - General Practice Physician |
| Is Primary | No |
| Taxonomy Code | 246Z00000X - Other Specialist/Technologist |
| Is Primary | No |
| Taxonomy Code | 251J00000X - Nursing Care Agency |
| Is Primary | No |
| Taxonomy Code | 261QR0405X - Substance Use Disorder Rehabilitation Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 261QR1100X - Research Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 363LA2200X - Adult Health Nurse Practitioner |
| Is Primary | No |
| Taxonomy Code | 363LF0000X - Family Nurse Practitioner |
| Is Primary | No |
| Taxonomy Code | 363LP0808X - Psychiatric/Mental Health Nurse Practitioner |
| Is Primary | No |
| Taxonomy Code | 363LP2300X - Primary Care Nurse Practitioner |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| Bouldin, Jay | Agent | 1030 VENETIAN WAY, UNITE 202, MELBOURNE, FL 32904 |
| Name | Role | Address |
|---|---|---|
| BOULDIN, JAY | Chief Executive Officer | 1030 VENETIAN DR, UNIT 202, MELBOURNE, FL 32904 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2023-10-02 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2023-05-30 | Bouldin, Jay | No data |
| Name | Date |
|---|---|
| VOLUNTARY DISSOLUTION | 2023-10-02 |
| AMENDED ANNUAL REPORT | 2023-05-30 |
| ANNUAL REPORT | 2023-01-17 |
| Florida Limited Liability | 2022-08-30 |
Date of last update: 11 Feb 2025
Sources: Florida Department of State
