| Entity Name: | THE MEDICAL STORE OF PALM BEACH COUNTY, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Not For Profit Corporation |
| Status: | Active |
| Date Filed: | 10 May 2005 (20 years ago) |
| Last Event: | AMENDED AND RESTATED ARTICLES |
| Event Date Filed: | 30 Nov 2007 (17 years ago) |
| Document Number: | N05000004848 |
| FEI/EIN Number | 20-2835810 |
| Address: | 5300 EAST AVENUE, WEST PALM BEACH, FL 33407 |
| Mail Address: | 5300 EAST AVENUE, WEST PALM BEACH, FL 33407 |
| ZIP code: | 33407 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1932114667 | 2006-07-30 | 2013-01-15 | 5300 EAST AVE, WEST PALM BEACH, FL, 334072387, US | 300 NORTHPOINT PKWY, SUITE 301, WEST PALM BEACH, FL, 334071979, US | |||||||||||||||||||||||||||||||||||
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| Phone | +1 561-848-5200 |
| Phone | +1 561-242-6200 |
| Fax | 5612426240 |
Authorized person
| Name | MR. DAVID C. FIELDING |
| Role | PRESIDENT AND CEO |
| Phone | 5618485200 |
Taxonomy
| Taxonomy Code | 332B00000X - Durable Medical Equipment & Medical Supplies |
| License Number | 1030 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 332BC3200X - Customized Equipment (DME) |
| License Number | 1030 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 030998200 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Lowry, Tarrah | Agent | 5300 EAST AVENUE, WEST PALM BEACH, FL 33407 |
| Name | Role | Address |
|---|---|---|
| Lowry, Tarrah | Interim President | 5300 EAST AVENUE, WEST PALM BEACH, FL 33407 |
| Name | Role | Address |
|---|---|---|
| Cook, Mark | Vice Chairman | 5300 East Avenue, West Palm Beach, FL 33407 |
| Name | Role | Address |
|---|---|---|
| Brazzale, Katherine, Dr. | Chief Medical Officer | 5300 EAST AVENUE, WEST PALM BEACH, FL 33407 |
| Name | Role | Address |
|---|---|---|
| Quinn, William | Chairman of the Board | 5300 EAST AVENUE, WEST PALM BEACH, FL 33407 |
| Name | Role | Address |
|---|---|---|
| Burns, Tom | Treasurer | 5300 EAST AVENUE, WEST PALM BEACH, FL 33407 |
| Name | Role | Address |
|---|---|---|
| Huntley, Mark R | Vice President | 5300 EAST AVENUE, WEST PALM BEACH, FL 33407 |
| Name | Role | Address |
|---|---|---|
| Huntley, Mark R | Chief Financial Officer | 5300 EAST AVENUE, WEST PALM BEACH, FL 33407 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G16000015899 | THE MEDICAL STORE | ACTIVE | 2016-02-12 | 2026-12-31 | No data | 5300 EAST AVE, WEST PALM BEACH, FL, 33407 |
| G16000015669 | THE MEDICAL STORE, INC. | ACTIVE | 2016-02-11 | 2026-12-31 | No data | 5300 EAST AVE, WEST PALM BEACH, FL, 33407 |
| G16000015672 | THE MEDICAL STORE OF PALM BEACH COUNTY, INC. | ACTIVE | 2016-02-11 | 2026-12-31 | No data | 5300 EAST AVE, WEST PALM BEACH, FL, 33407 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2025-01-09 | Lowry, Tarrah | No data |
| REGISTERED AGENT NAME CHANGED | 2017-08-18 | Fielding, David | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2010-01-13 | 5300 EAST AVENUE, WEST PALM BEACH, FL 33407 | No data |
| AMENDED AND RESTATEDARTICLES | 2007-11-30 | No data | No data |
| AMENDMENT | 2006-05-22 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-09 |
| ANNUAL REPORT | 2024-03-11 |
| ANNUAL REPORT | 2023-03-06 |
| ANNUAL REPORT | 2022-02-17 |
| ANNUAL REPORT | 2021-01-13 |
| ANNUAL REPORT | 2020-01-30 |
| ANNUAL REPORT | 2019-01-04 |
| ANNUAL REPORT | 2018-01-31 |
| AMENDED ANNUAL REPORT | 2017-08-18 |
| AMENDED ANNUAL REPORT | 2017-04-24 |
Date of last update: 29 Jan 2025
Sources: Florida Department of State
