| Entity Name: | MERCY MEDICAL DEVELOPMENT, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Non-Profit |
| Status: | Inactive |
| Date Filed: | 24 May 1985 (40 years ago) |
| Document Number: | N09556 |
| FEI/EIN Number | 592789194 |
| Address: | 4725 NORTH FEDERAL HIGHWAY, FORT LAUDERDALE, FL, 33308, US |
| Mail Address: | 4725 NORTH FEDERAL HIGHWAY, FORT LAUDERDALE, FL, 33308, US |
| ZIP code: | 33308 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1992787576 | 2005-11-18 | 2008-05-29 | PO BOX 331966, MIAMI, FL, 332331966, US | 3641 S MIAMI AVE, MIAMI, FL, 331334205, US | |||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 305-860-4660 |
| Fax | 3058604682 |
Authorized person
| Name | MR. JERRY MASHBURN |
| Role | CFO |
| Phone | 3058544400 |
Taxonomy
| Taxonomy Code | 207RP1001X - Pulmonary Disease Physician |
| Is Primary | No |
| Taxonomy Code | 207UN0901X - Nuclear Cardiology Physician |
| Is Primary | No |
| Taxonomy Code | 207ZP0102X - Anatomic Pathology & Clinical Pathology Physician |
| Is Primary | No |
| Taxonomy Code | 2085N0904X - Nuclear Radiology Physician |
| Is Primary | No |
| Taxonomy Code | 2085R0202X - Diagnostic Radiology Physician |
| Is Primary | Yes |
| Taxonomy Code | 2085R0203X - Therapeutic Radiology Physician |
| Is Primary | No |
| Taxonomy Code | 2085R0204X - Vascular & Interventional Radiology Physician |
| Is Primary | No |
| Taxonomy Code | 2085U0001X - Diagnostic Ultrasound Physician |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 060942100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| WEBBER DALE S | Agent | 401 E. JACKSON ST., STE. 2500, TAMPA, FL, 33602 |
| Name | Role | Address |
|---|---|---|
| WATTS HOWARD | Chairman | 4725 NORTH FEDERAL HIGHWAY, FORT LAUDERDALE, FL, 33308 |
| Name | Role | Address |
|---|---|---|
| WILFORD LINDA V | Director | 4725 NORTH FEDERAL HIGHWAY, FORT LAUDERDALE, FL, 33308 |
| WORLEY, SSJ SR. ELIZABETH | Director | 9401 BISCAYNE BLVD., MIAMI SHORES, FL, 33138 |
| FITZGERALD J P | Director | 110 MERRICK WAY, SUITE 3B, CORAL GABLES, FL, 33131 |
| MARIN TOMAS M | Director | 5400 SW 102 AVE, MIAMI, FL, 33165 |
| Stoecker, SSJ Jane | Director | 241 St. George Street, St. Augustine, FL, 32085 |
| WATTS HOWARD | Director | 4725 NORTH FEDERAL HIGHWAY, FORT LAUDERDALE, FL, 33308 |
| Name | Role | Address |
|---|---|---|
| WORLEY, SSJ SR. ELIZABETH | Secretary | 9401 BISCAYNE BLVD., MIAMI SHORES, FL, 33138 |
| Name | Role | Address |
|---|---|---|
| WILFORD LINDA V | Treasurer | 4725 NORTH FEDERAL HIGHWAY, FORT LAUDERDALE, FL, 33308 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G08039700034 | MERCY LABORATORY ASSOCIATES | EXPIRED | 2008-02-08 | 2013-12-31 | No data | 3663 SOUTH MIAMI AVE, MIAMI, FL, 33133 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| MERGER | 2014-06-27 | No data | CORPORATION WAS PART OF A MERGER. QUALIFIED CORPORATION WAS 705193. MERGER NUMBER 300000141763 |
| AMENDMENT | 2011-07-19 | No data | No data |
| AMENDED AND RESTATEDARTICLES | 2003-11-21 | No data | No data |
| AMENDED AND RESTATEDARTICLES | 2003-04-11 | No data | No data |
| AMENDMENT | 2002-12-16 | No data | No data |
| AMENDED AND RESTATEDARTICLES | 1999-02-01 | No data | No data |
| AMENDMENT AND NAME CHANGE | 1995-06-01 | MERCY MEDICAL DEVELOPMENT, INC. | No data |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
