| Entity Name: | CONCEPT EFL IMAGING CENTER, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Limited Liability Co. |
| Status: | Active |
| Date Filed: | 05 Nov 2004 (20 years ago) |
| Document Number: | M04000004821 |
| FEI/EIN Number | 421649993 |
| Address: | ONE PARK PLAZA, NASHVILLE, TN, 37203, US |
| Mail Address: | PO BOX 750, NASHVILLE, TN, 37202, US |
| Place of Formation: | DELAWARE |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1891757480 | 2006-04-06 | 2010-05-18 | 2290 10TH AVE N, SUITE 101, LAKE WORTH, FL, 334616607, US | 2290 10TH AVE N, SUITE 101, LAKE WORTH, FL, 334616607, US | |||||||||||||||||||||
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| Phone | +1 561-540-8100 |
| Fax | 5614932261 |
Authorized person
| Name | WANDA FOGARTY |
| Role | VP IMAGING SERVICES |
| Phone | 5618383630 |
Taxonomy
| Taxonomy Code | 2085R0202X - Diagnostic Radiology Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 272322100 |
| State | FL |
| Name | Role |
|---|---|
| C T CORPORATION SYSTEM | Agent |
| Name | Role | Address |
|---|---|---|
| FRANCK II JOHN M | Manager | ONE PARK PLAZA, NASHVILLE, TN, 37203 |
| WYATT CHRISTOPHER F | Manager | ONE PARK PLAZA, NASHVILLE, TN, 37203 |
| HAZEN SAMUEL N | Manager | ONE PARK PLAZA, NASHVILLE, TN, 37203 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2008-04-18 | ONE PARK PLAZA, NASHVILLE, TN 37203 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2005-04-28 | ONE PARK PLAZA, NASHVILLE, TN 37203 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-19 |
| ANNUAL REPORT | 2023-04-18 |
| ANNUAL REPORT | 2022-04-24 |
| ANNUAL REPORT | 2021-04-20 |
| ANNUAL REPORT | 2020-04-27 |
| ANNUAL REPORT | 2019-04-18 |
| ANNUAL REPORT | 2018-04-18 |
| ANNUAL REPORT | 2017-04-20 |
| ANNUAL REPORT | 2016-04-21 |
| ANNUAL REPORT | 2015-04-21 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
