| Entity Name: | LAKE EMERGENCY MEDICAL SERVICES, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Not For Profit Corporation |
| Status: | Inactive |
| Date Filed: | 14 Jul 2011 (14 years ago) |
| Date of dissolution: | 19 Oct 2020 (4 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 19 Oct 2020 (4 years ago) |
| Document Number: | N11000006738 |
| FEI/EIN Number | 45-2797089 |
| Address: | 315 WEST MAIN STREET, OFFICE OF EMS, TAVARES, FL 32778 |
| Mail Address: | PO Box 7800, TAVARES, FL 32778 |
| ZIP code: | 32778 |
| County: | Lake |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1497034318 | 2011-08-09 | 2012-01-18 | 2761 WEST OLD HIGHWAY 441, MOUNT DORA, FL, 32757, US | 2761 WEST OLD HIGHWAY 441, MOUNT DORA, FL, 32757, US | |||||||||||||||||||||||||
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| Phone | +1 352-383-4554 |
| Fax | 3523859063 |
Authorized person
| Name | MR. WELTON G. CADWELL |
| Role | BOARD CHAIRMAN |
| Phone | 3523439850 |
Taxonomy
| Taxonomy Code | 3416L0300X - Land Ambulance |
| License Number | ALS3503 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 004071400 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MARSH, MELANIE | Agent | LAKE COUNTY ATTORNEY, 315 WEST MAIN STREET, TAVARES, FL 32778 |
| Name | Role | Address |
|---|---|---|
| SULLIVAN, TIM | Director | 315 WEST MAIN STREET, TAVARES, FL 32778 |
| BREEDEN, WENDY | Director | 315 WEST MAIN STREET, TAVARES, FL 32778 |
| CAMPIONE, LESLIE | Director | 315 WEST MAIN STREET, TAVARES, FL 32778 |
| PARKS, SEAN M | Director | 315 WEST MAIN STREET, TAVARES, FL 32778 |
| BLAKE, JOSH | Director | 315 WEST MAIN STREET, TAVARES, FL 32778 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2020-10-19 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2019-02-06 | 315 WEST MAIN STREET, OFFICE OF EMS, TAVARES, FL 32778 | No data |
| REGISTERED AGENT NAME CHANGED | 2019-02-06 | MARSH, MELANIE | No data |
| CHANGE OF MAILING ADDRESS | 2018-11-08 | 315 WEST MAIN STREET, OFFICE OF EMS, TAVARES, FL 32778 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2018-11-08 | LAKE COUNTY ATTORNEY, 315 WEST MAIN STREET, TAVARES, FL 32778 | No data |
| REINSTATEMENT | 2018-11-08 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2018-09-28 | No data | No data |
| Name | Date |
|---|---|
| Voluntary Dissolution | 2020-10-19 |
| ANNUAL REPORT | 2020-03-10 |
| ANNUAL REPORT | 2019-02-06 |
| REINSTATEMENT | 2018-11-08 |
| ANNUAL REPORT | 2017-02-23 |
| ANNUAL REPORT | 2016-01-26 |
| Reg. Agent Change | 2015-10-12 |
| ANNUAL REPORT | 2015-04-09 |
| ANNUAL REPORT | 2014-04-14 |
| ANNUAL REPORT | 2013-03-22 |
Date of last update: 24 Jan 2025
Sources: Florida Department of State
