| Entity Name: | INDIAN ROCKS MEDICAL CENTER, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Not For Profit Corporation |
| Status: | Inactive |
| Date Filed: | 09 Jun 1999 (26 years ago) |
| Date of dissolution: | 25 Sep 2009 (15 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 25 Sep 2009 (15 years ago) |
| Document Number: | N99000003595 |
| FEI/EIN Number | 59-3587767 |
| Address: | 12685 ULMERTON ROAD, LARGO, FL 33774 |
| Mail Address: | 12685 ULMERTON ROAD, LARGO, FL 33774 |
| ZIP code: | 33774 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1629075874 | 2005-07-01 | 2020-08-22 | 12685 ULMERTON RD, LARGO, FL, 337743603, US | 12685 ULMERTON RD, LARGO, FL, 337743603, US | |||||||||||||||||||
|
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| Phone | +1 727-593-8700 |
| Fax | 7275938701 |
Authorized person
| Name | SAMARA L VANDERGRAFF |
| Role | OFFICE MANAGER |
| Phone | 7275938700 |
Taxonomy
| Taxonomy Code | 261Q00000X - Clinic/Center |
| License Number | OS0007369 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| FERGUSON, TIMOTHY A | Agent | 12685 ULMERTON ROAD, LARGO, FL 33774 |
| Name | Role | Address |
|---|---|---|
| HARRELL, GLENN | Director | 12685 ULMERTON RD., LARGO, FL 33774 |
| JOHNSON, KARIN | Director | 12685 ULMERTON RD., LARGO, FL 33774 |
| DIAZ, FERNANDO | Director | 12685 ULMERTON RD., LARGO, FL 33774 |
| JANECKI, CHET | Director | 12685 ULMERTON RD, LARGO, FL 33774 |
| Name | Role | Address |
|---|---|---|
| JOHNSON, KARIN | Secretary | 12685 ULMERTON RD., LARGO, FL 33774 |
| Name | Role |
|---|---|
| JONES-KELLY INCORPORATED | Treasurer |
| Name | Role | Address |
|---|---|---|
| FERGUSON, TIMOTHY | President | 12685 ULMERTON RD., LARGO, FL 33774 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2009-09-25 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2007-05-03 | 12685 ULMERTON ROAD, LARGO, FL 33774 | No data |
| CHANGE OF MAILING ADDRESS | 2007-05-03 | 12685 ULMERTON ROAD, LARGO, FL 33774 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2007-05-03 | 12685 ULMERTON ROAD, LARGO, FL 33774 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2008-05-02 |
| ANNUAL REPORT | 2007-05-03 |
| ANNUAL REPORT | 2006-05-03 |
| ANNUAL REPORT | 2005-05-02 |
| ANNUAL REPORT | 2004-04-30 |
| ANNUAL REPORT | 2003-05-05 |
| ANNUAL REPORT | 2002-02-17 |
| ANNUAL REPORT | 2001-02-09 |
| ANNUAL REPORT | 2000-05-15 |
| Domestic Non-Profit | 1999-06-11 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
