| Entity Name: | NORTH FLORIDA CANCER CENTER LIVE OAK, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Limited Liability Co. |
| Status: | Active |
| Date Filed: | 07 Jan 2005 (20 years ago) |
| Document Number: | M05000000120 |
| FEI/EIN Number | 522448730 |
| Address: | ONE PARK PLAZA, NASHVILLE, TN, 37203, US |
| Mail Address: | ONE PARK PLAZA, LEGAL DEPT., NASHVILLE, TN, 37203, US |
| Place of Formation: | DELAWARE |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1730176215 | 2005-09-30 | 2008-03-18 | 1500 OHIO AVE N, LIVE OAK, FL, 320644820, US | 1500 OHIO AVE N, LIVE OAK, FL, 320644820, US | |||||||||||||||||||||
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| Phone | +1 386-362-1174 |
| Fax | 3863621142 |
Authorized person
| Name | MR. LAVELLE HARDIN |
| Role | CREDENTIALING COORDINATOR |
| Phone | 6153448203 |
Taxonomy
| Taxonomy Code | 2085R0001X - Radiation Oncology Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | RR MEDICARE |
| Number | DD1688 |
| State | FL |
| Name | Role |
|---|---|
| C T CORPORATION SYSTEM | Agent |
| Name | Role | Address |
|---|---|---|
| WYATT CHRISTOPHER F | Manager | ONE PARK PLAZA, NASHVILLE, TN, 37203 |
| Foster Jon M | 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 | 2012-04-30 | ONE PARK PLAZA, NASHVILLE, TN 37203 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2006-04-24 | ONE PARK PLAZA, NASHVILLE, TN 37203 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-16 |
| ANNUAL REPORT | 2023-04-18 |
| ANNUAL REPORT | 2022-04-22 |
| ANNUAL REPORT | 2021-04-26 |
| ANNUAL REPORT | 2020-04-29 |
| ANNUAL REPORT | 2019-04-17 |
| ANNUAL REPORT | 2018-04-17 |
| ANNUAL REPORT | 2017-04-21 |
| ANNUAL REPORT | 2016-04-22 |
| ANNUAL REPORT | 2015-04-21 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
