| Entity Name: | WESTSIDE SAMARITANS CLINIC INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Non-Profit |
| Status: |
Inactive
The business entity is inactive. This status may signal operational issues or voluntary closure, raising concerns about the business's ability to repay loans and requiring careful risk assessment by lenders. |
| Date Filed: | 18 Jan 2012 (13 years ago) |
| Date of dissolution: | 27 Sep 2024 (7 months ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 27 Sep 2024 (7 months ago) |
| Document Number: | N12000000613 |
| FEI/EIN Number |
90-0786544
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 1029 NE 9th Street, Gainesville, FL, 32601, US |
| Mail Address: | 1029 NE 9th Street, Gainesville, FL, 32601, US |
| ZIP code: | 32601 |
| County: | Alachua |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1851651988 | 2012-05-23 | 2013-12-04 | 10000 W NEWBERRY RD, GAINESVILLE, FL, 326065544, US | 10000 W NEWBERRY RD, GAINESVILLE, FL, 326065544, US | |||||||||||||||||||||||||
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| Phone | +1 352-333-7700 |
| Fax | 3523339009 |
Authorized person
| Name | DR. ROY TAYLOR KLOSSNER |
| Role | DIRECTOR |
| Phone | 3523337700 |
Taxonomy
| Taxonomy Code | 261QF0400X - Federally Qualified Health Center (FQHC) |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 261QM1300X - Multi-Specialty Clinic/Center |
| License Number | N12000000613-VHCPP |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| Steven Williams | Director | 2630 NW 39th Avenue, Gainesville, FL, 32605 |
| McMahon Elizabeth | Treasurer | 4190 NW 50th Drive #7112, Gainesville, FL, 32606 |
| Dixon James | President | 2001 SW 16th Street, Gainesville, FL, 32608 |
| Williams Steven G | Agent | 2630 NW 39th Avenue, Gainesville, FL, 32605 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G14000047434 | SAMARITAN'S HEALTHCARE | EXPIRED | 2014-05-13 | 2019-12-31 | - | 1201 NW 64TH TERRACE, GAINESVILLE, FL, 32605 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2024-09-27 | - | - |
| REGISTERED AGENT NAME CHANGED | 2020-08-04 | Williams, Steven G | - |
| REINSTATEMENT | 2020-08-04 | - | - |
| REGISTERED AGENT ADDRESS CHANGED | 2020-08-04 | 2630 NW 39th Avenue, Gainesville, FL 32605 | - |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2019-09-27 | - | - |
| CHANGE OF PRINCIPAL ADDRESS | 2017-03-30 | 1029 NE 9th Street, Gainesville, FL 32601 | - |
| CHANGE OF MAILING ADDRESS | 2017-03-30 | 1029 NE 9th Street, Gainesville, FL 32601 | - |
| AMENDMENT | 2012-10-18 | - | - |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2023-02-14 |
| ANNUAL REPORT | 2022-03-16 |
| ANNUAL REPORT | 2021-05-05 |
| REINSTATEMENT | 2020-08-04 |
| ANNUAL REPORT | 2018-04-30 |
| ANNUAL REPORT | 2017-03-30 |
| ANNUAL REPORT | 2016-03-17 |
| ANNUAL REPORT | 2015-02-21 |
| ANNUAL REPORT | 2014-04-08 |
| ANNUAL REPORT | 2013-03-22 |
Date of last update: 01 Apr 2025
Sources: Florida Department of State
