| Entity Name: | BERT FISH MEDICAL CENTER, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Non-Profit |
| Status: | Active |
| Date Filed: | 13 Mar 1995 (30 years ago) |
| Document Number: | N95000001178 |
| FEI/EIN Number | 593306983 |
| Address: | 909 Carey Drive, South Daytona, FL, 32119, US |
| Mail Address: | PO BOX 909, NEW SMYRNA BEACH, FL, 32170, US |
| ZIP code: | 32119 |
| County: | Volusia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1245275734 | 2006-06-18 | 2015-05-15 | 401 PALMETTO ST, P.O. BOX 1350, NEW SMYRNA BEACH, FL, 321687322, US | 401 PALMETTO ST, NEW SMYRNA BEACH, FL, 321687322, US | |||||||||||||||||||||||
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| Phone | +1 386-424-5000 |
Authorized person
| Name | MR. AL ALLRED |
| Role | CFO |
| Phone | 3864245261 |
Taxonomy
| Taxonomy Code | 282N00000X - General Acute Care Hospital |
| License Number | 4054 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 010183400 |
| State | FL |
| LEI number | Registered As | Jurisdiction Of Formation | General Category | Entity Status | Entity created at | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 549300KH311MT8TXEY22 | N95000001178 | US-FL | GENERAL | ACTIVE | No data | |||||||||||||||||||
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| Legal | C/O Steve Harrell, 401 Palmetto Street, New Smyrna Beach, US-FL, US, 32168 |
| Headquarters | 401 Palmetto Street, New Smyrna Beach, US-FL, US, 32168 |
Registration details
| Registration Date | 2013-03-22 |
| Last Update | 2023-08-04 |
| Status | LAPSED |
| Next Renewal | 2015-03-07 |
| LEI Issuer | 5493001KJTIIGC8Y1R12 |
| Corroboration Level | FULLY_CORROBORATED |
| Data Validated As | N95000001178 |
| Name | Role | Address |
|---|---|---|
| DAVIDSON JEFF | Agent | 909 Carey Drive, South Daytona, FL, 32119 |
| Name | Role | Address |
|---|---|---|
| PRESTON WILLIAM | Chairman | 605 SOUTH ORANGE STREET, NEW SMYRNA BEACH, FL, 32168 |
| Name | Role | Address |
|---|---|---|
| Card Harold | Secretary | 3019 WILLOW OAK DRIVE, EDGEWATER, FL, 32141 |
| Name | Role | Address |
|---|---|---|
| DAVIDSON JEFF | Chief Financial Officer | 305 MAGNOLIA STREET, NEW SMYRNA BEACH, FL, 32168 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G15000011910 | BFMC COMMUNITY HEALTH CENTER | EXPIRED | 2015-02-03 | 2020-12-31 | No data | 401 PALMETTO STREET, NEW SMYRNA BEACH, FL, 32168 |
| G11000050281 | BERT FISH EDGEWATER IMAGING AND DIAGNOSTIC CENTER | EXPIRED | 2011-05-27 | 2016-12-31 | No data | 239 N. RIDGEWOOD AVENUE, EDGEWATER, FL, 32132 |
| G11000048975 | BERT FISH MEDICAL CENTER | ACTIVE | 2011-05-24 | 2026-12-31 | No data | PO BOX 909, NEW SMYRNA BEACH, FL, 32170, US |
| G08042900615 | CORONADO RHEUMATOLOGY CARE | EXPIRED | 2008-02-11 | 2013-12-31 | No data | 401 PALMETTO STREET, NEW SMYRNA BEACH, FL, 32168 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| AMENDED AND RESTATEDARTICLES | 2011-06-28 | No data | No data |
| MERGER | 2010-07-01 | No data | CORPORATION WAS A MERGER RESULT. TOTAL NUMBER OF QUALIFIED CORPORATION(S) INVOLVED WAS 1. MERGER NUMBER 900000106039 |
| RESTATED ARTICLES | 2010-07-01 | No data | No data |
| AMENDMENT | 1995-06-30 | No data | No data |
Date of last update: 03 Jan 2025
Sources: Florida Department of State
