| Entity Name: | OMNI FAMILY MEDICINE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 10 Jun 1999 (26 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 08 Dec 2003 (21 years ago) |
| Document Number: | L99000003355 |
| FEI/EIN Number | 593582210 |
| Address: | 8030 Saint James Way, Mount Dora, FL, 32757, US |
| Mail Address: | 8030 Saint James Way, Mount Dora, FL, 32757, US |
| ZIP code: | 32757 |
| County: | Lake |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1063785095 | 2012-02-22 | 2016-05-10 | 8030 SAINT JAMES WAY, MOUNT DORA, FL, 327579134, US | 8030 SAINT JAMES WAY, MOUNT DORA, FL, 327579134, US | |||||||||||||||||||
|
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| Phone | +1 407-908-0064 |
| Fax | 3523839319 |
Authorized person
| Name | DR. JERRY M ALSTOTT |
| Role | OWNER |
| Phone | 4079080064 |
Taxonomy
| Taxonomy Code | 207QA0505X - Adult Medicine Physician |
| License Number | ME0037307 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| ALSTOTT JERRY MMD | Agent | 8030 Saint James Way, Mount Dora, FL, 32757 |
| Name | Role | Address |
|---|---|---|
| ALSTOTT JERRY MMD | Manager | 8030 Saint James Way, Mount Dora, FL, 32757 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2016-01-18 | 8030 Saint James Way, Mount Dora, FL 32757 | No data |
| CHANGE OF MAILING ADDRESS | 2016-01-18 | 8030 Saint James Way, Mount Dora, FL 32757 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2016-01-18 | 8030 Saint James Way, Mount Dora, FL 32757 | No data |
| REGISTERED AGENT NAME CHANGED | 2013-01-28 | ALSTOTT, JERRY M, MD | No data |
| REINSTATEMENT | 2003-12-08 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2002-10-04 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-14 |
| ANNUAL REPORT | 2023-01-30 |
| ANNUAL REPORT | 2022-02-01 |
| ANNUAL REPORT | 2021-02-06 |
| ANNUAL REPORT | 2020-02-29 |
| ANNUAL REPORT | 2019-02-28 |
| ANNUAL REPORT | 2018-01-15 |
| ANNUAL REPORT | 2017-01-09 |
| ANNUAL REPORT | 2016-01-18 |
| ANNUAL REPORT | 2015-01-13 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
