| Entity Name: | HEATHROW IMAGING, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Limited Liability Co. |
| Status: | Active |
| Date Filed: | 15 Feb 2007 (18 years ago) |
| Last Event: | LC NAME CHANGE |
| Event Date Filed: | 07 Jun 2007 (18 years ago) |
| Document Number: | M07000000952 |
| FEI/EIN Number | 043830722 |
| Address: | ONE PARK PLAZA, NASHVILLE, TN, 32703, US |
| Mail Address: | ONE PARK PLAZA, ATTN: LEGAL DEPARTMENT, NASHVILLE, TN, 32703, US |
| ZIP code: | 32703 |
| County: | Orange |
| Place of Formation: | DELAWARE |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1043416928 | 2007-06-26 | 2009-10-15 | 1343 SOUTH INTERNATIONAL PARKWAY, SUITE 1351 BLDG 3, LAKE MARY, FL, 327461401, US | 1343 SOUTH INTERNATIONAL PARKWAY, SUITE 1351 BLDG 3, LAKE MARY, FL, 327461401, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 407-333-4464 |
| Fax | 4073334393 |
Authorized person
| Name | MR. LAVELLE R HARDIN |
| Role | CREDENTIALING COORDINATOR |
| Phone | 6153448203 |
Taxonomy
| Taxonomy Code | 2085R0202X - Diagnostic Radiology Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 001115600 |
| State | FL |
| Issuer | BCBS OF FL |
| Number | V3203 |
| State | FL |
| Issuer | RR MEDICARE |
| Number | DN3311 |
| State | FL |
| Name | Role |
|---|---|
| C T CORPORATION SYSTEM | Agent |
| Name | Role |
|---|---|
| IMAGING SERVICES OF ORLANDO, LLC | Managing Member |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2011-08-16 | ONE PARK PLAZA, NASHVILLE, TN 32703 | No data |
| CHANGE OF MAILING ADDRESS | 2011-08-16 | ONE PARK PLAZA, NASHVILLE, TN 32703 | No data |
| LC NAME CHANGE | 2007-06-07 | HEATHROW IMAGING, LLC | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-30 |
| ANNUAL REPORT | 2023-04-20 |
| ANNUAL REPORT | 2022-04-22 |
| ANNUAL REPORT | 2021-04-23 |
| ANNUAL REPORT | 2020-04-28 |
| ANNUAL REPORT | 2019-04-17 |
| ANNUAL REPORT | 2018-04-17 |
| ANNUAL REPORT | 2017-04-22 |
| ANNUAL REPORT | 2016-04-26 |
| ANNUAL REPORT | 2015-04-21 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
