| Entity Name: | WESTSIDE SAMARITANS CLINIC INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Non-Profit |
| Status: | Inactive |
| Date Filed: | 18 Jan 2012 (13 years ago) |
| Date of dissolution: | 27 Sep 2024 (4 months ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 27 Sep 2024 (4 months ago) |
| Document Number: | N12000000613 |
| FEI/EIN Number | 90-0786544 |
| 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 |
|---|---|---|
| Williams Steven G | Agent | 2630 NW 39th Avenue, Gainesville, FL, 32605 |
| Name | Role | Address |
|---|---|---|
| Steven Williams | Director | 2630 NW 39th Avenue, Gainesville, FL, 32605 |
| Name | Role | Address |
|---|---|---|
| McMahon Elizabeth | Treasurer | 4190 NW 50th Drive #7112, Gainesville, FL, 32606 |
| Name | Role | Address |
|---|---|---|
| Dixon James | President | 2001 SW 16th Street, Gainesville, FL, 32608 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G14000047434 | SAMARITAN'S HEALTHCARE | EXPIRED | 2014-05-13 | 2019-12-31 | No data | 1201 NW 64TH TERRACE, GAINESVILLE, FL, 32605 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2024-09-27 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2020-08-04 | Williams, Steven G | No data |
| REINSTATEMENT | 2020-08-04 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-08-04 | 2630 NW 39th Avenue, Gainesville, FL 32605 | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2019-09-27 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2017-03-30 | 1029 NE 9th Street, Gainesville, FL 32601 | No data |
| CHANGE OF MAILING ADDRESS | 2017-03-30 | 1029 NE 9th Street, Gainesville, FL 32601 | No data |
| AMENDMENT | 2012-10-18 | No data | No data |
| 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 Feb 2025
Sources: Florida Department of State
