| Entity Name: | DIVERSIFIED MEDICAL GROUP, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Inactive |
| Date Filed: | 18 Nov 1987 (37 years ago) |
| Date of dissolution: | 23 Sep 2016 (8 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 23 Sep 2016 (8 years ago) |
| Document Number: | M62699 |
| FEI/EIN Number | 65-0013553 |
| Address: | 18619 SW 107TH AVENUE, MIAMI, FL 33157 |
| Mail Address: | 18619 SW 107TH AVENUE, MIAMI, FL 33157 |
| ZIP code: | 33157 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1033286034 | 2006-11-29 | 2009-03-30 | 18619 SW 107TH AVE, CUTLER BAY, FL, 331576728, US | 18619 SW 107TH AVE, CUTLER BAY, FL, 331576728, US | |||||||||||||||||||||||||
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| Phone | +1 305-662-8559 |
| Fax | 3056676280 |
Authorized person
| Name | MR. GABRIEL A DELGADO |
| Role | PRESIDENT |
| Phone | 3056628559 |
Taxonomy
| Taxonomy Code | 332BX2000X - Oxygen Equipment & Supplies (DME) |
| License Number | 847 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 025107100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| DELGADO, GABRIEL A | Agent | 18619 SW 107 AVENUE, MIAMI, FL 33157 |
| Name | Role | Address |
|---|---|---|
| DELGADO, GABRIEL A | President | 18619 SW 107TH AVENUE, MIAMI, FL 33157 |
| Name | Role | Address |
|---|---|---|
| DELGADO, GABRIEL A | Director | 18619 SW 107TH AVENUE, MIAMI, FL 33157 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2016-09-23 | No data | No data |
| AMENDMENT | 2012-02-15 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2011-01-19 | DELGADO, GABRIEL A | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2011-01-19 | 18619 SW 107 AVENUE, MIAMI, FL 33157 | No data |
| AMENDMENT | 2011-01-07 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2010-01-04 | 18619 SW 107TH AVENUE, MIAMI, FL 33157 | No data |
| CHANGE OF MAILING ADDRESS | 2010-01-04 | 18619 SW 107TH AVENUE, MIAMI, FL 33157 | No data |
| AMENDMENT | 2002-07-12 | No data | No data |
| NAME CHANGE AMENDMENT | 1989-04-12 | DIVERSIFIED MEDICAL GROUP, INC. | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J24000151082 | ACTIVE | CACE15013384 | BROWARD COUNTY CIRCUIT COURT | 2018-04-30 | 2029-03-14 | $577,366.14 | J.R. WEINSTEIN, INC. D/B/A RESOURCE SERVICES, 4019 S.W. 30TH AVENUE, FORT LAUDERDALE, FL 33312 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2015-01-15 |
| ANNUAL REPORT | 2014-01-03 |
| ANNUAL REPORT | 2013-04-09 |
| Amendment | 2012-02-15 |
| ANNUAL REPORT | 2012-01-05 |
| ANNUAL REPORT | 2011-01-19 |
| Amendment | 2011-01-07 |
| ANNUAL REPORT | 2010-07-16 |
| ANNUAL REPORT | 2010-01-04 |
| ANNUAL REPORT | 2009-01-07 |
Date of last update: 04 Feb 2025
Sources: Florida Department of State
