| Entity Name: | MEMORIAL SOUTHSIDE CANCER CENTER, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Limited Liability Co. |
| Status: |
Inactive
The business entity is inactive. This status may signal operational issues or voluntary closure, raising concerns about the business's ability to repay loans and requiring careful risk assessment by lenders. |
| Date Filed: | 29 Nov 2005 (19 years ago) |
| Date of dissolution: | 28 Feb 2023 (2 years ago) |
| Last Event: | WITHDRAWAL |
| Event Date Filed: | 28 Feb 2023 (2 years ago) |
| Document Number: | M05000006565 |
| FEI/EIN Number |
760807743
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 2270 COLONIAL BOULEVARD, FT. MYERS, FL, 33907, US |
| Mail Address: | 2270 COLONIAL BOULEVARD, FT. MYERS, FL, 33907, US |
| ZIP code: | 33907 |
| County: | Lee |
| Place of Formation: | DELAWARE |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1588724033 | 2006-12-12 | 2010-01-27 | 5742 BOOTH RD, SUITE B, JACKSONVILLE, FL, 32207, US | 5742 BOOTH RD, SUITE B, JACKSONVILLE, FL, 32207, US | |||||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||||
| Phone | +1 904-636-6911 |
| Fax | 9046366330 |
Authorized person
| Name | MR. LAVELLE HARDIN |
| Role | CREDENTIALING COORDINATOR |
| Phone | 6153448203 |
Taxonomy
| Taxonomy Code | 261QX0203X - Radiation Oncology Clinic/Center |
| License Number | APPLYING |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | RR MEDICARE |
| Number | DG1361 |
| State | FL |
| Issuer | BCBS OF FL |
| Number | 00389 |
| State | FL |
| Issuer | MEDICAID |
| Number | 277325200 |
| State | FL |
| Name | Role |
|---|---|
| CORPORATION SERVICE COMPANY | Agent |
| GENESISCARE USA, INC. | Member |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| WITHDRAWAL | 2023-02-28 | - | - |
| CHANGE OF PRINCIPAL ADDRESS | 2015-08-25 | 2270 COLONIAL BOULEVARD, FT. MYERS, FL 33907 | - |
| CHANGE OF MAILING ADDRESS | 2015-08-25 | 2270 COLONIAL BOULEVARD, FT. MYERS, FL 33907 | - |
| REGISTERED AGENT ADDRESS CHANGED | 2012-12-06 | 1201 HAYS STREET, TALLAHASSEE, FL 32301 | - |
| REGISTERED AGENT NAME CHANGED | 2012-12-06 | CORPORATION SERVICE COMPANY | - |
| REINSTATEMENT | 2012-12-06 | - | - |
| REVOKED FOR ANNUAL REPORT | 2012-09-28 | - | - |
| Name | Date |
|---|---|
| WITHDRAWAL | 2023-02-28 |
| AMENDED ANNUAL REPORT | 2022-05-10 |
| ANNUAL REPORT | 2022-04-21 |
| ANNUAL REPORT | 2021-04-19 |
| ANNUAL REPORT | 2020-01-17 |
| AMENDED ANNUAL REPORT | 2019-10-15 |
| ANNUAL REPORT | 2019-04-30 |
| ANNUAL REPORT | 2018-04-24 |
| ANNUAL REPORT | 2017-01-11 |
| ANNUAL REPORT | 2016-04-25 |
Date of last update: 02 Apr 2025
Sources: Florida Department of State
