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DWIC OF TAMPA BAY, INC.

Company Details

Entity Name: DWIC OF TAMPA BAY, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Inactive
Date Filed: 21 Feb 2000 (25 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: P00000018051
FEI/EIN Number 59-3625966
Address: 26812 U.S. Highway 19N, Clearwater, FL, 33761, US
Mail Address: 423 Fortress Blvd., Morgantown, WV, 26508, US
ZIP code: 33761
County: Pinellas
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1902376973 2018-12-03 2024-05-07 423 FORTRESS BLVD, MORGANTOWN, WV, 265081351, US 3700 US HIGHWAY 98 N UNIT 101, LAKELAND, FL, 338093863, US

Contacts

Phone +1 304-225-2500
Fax 3049856350
Phone +1 863-815-9523
Fax 8638159524

Authorized person

Name JOY KIMBALL
Role CONTRACT MANAGER
Phone 7633496740

Taxonomy

Taxonomy Code 207P00000X - Emergency Medicine Physician
Is Primary No
Taxonomy Code 261QU0200X - Urgent Care Clinic/Center
Is Primary Yes

Agent

Name Role
C T CORPORATION SYSTEM Agent

Director

Name Role Address
Balthazor Paul J Director 11020 Optum Circle, Minnetonka, MN, 55344
Ferrell, M.D. David R Director 423 Forterss Blvd, Morgantown, WV, 26508

Secretary

Name Role Address
Harper Jennifer L Secretary 11000 Optum Circle, Eden prairie, MN, 55343

Asst

Name Role Address
Lang Heather A Asst 9900 Bren Road East, Minnetonka, MN, 55343
Langdon Timothy J Asst 2717 N. 118th St.,Suite 300, Omaha, NE, 68164

Treasurer

Name Role Address
Gill Peter M Treasurer 9900 Bren Road East, Minnetonka, MN, 55343

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G23000103506 MEDEXPRESS URGENT CARE-GOLDEN GATE, COLLIER BLVD ACTIVE 2023-09-01 2028-12-31 No data 13005 COLLIER BLVD, NAPLES, FL, 34116
G23000100276 MEDEXPRESS-GOLDEN GATE, COLLIER BLVD ACTIVE 2023-08-28 2028-12-31 No data 13005 COLLIER BLVD, NAPLES, FL, 34116
G20000120957 MEDEXPRESS URGENT CARE-MYLAN-RECTRIX AERODROME CENTERS ACTIVE 2020-09-17 2025-12-31 No data 8250 15TH STREET, SARASOTA, FL, 34243
G20000120956 MEDEXPRESS URGENT CARE-MYLAN-FOUNTAINBLEAU AVIATION ACTIVE 2020-09-17 2025-12-31 No data 14200 NW 42RN AVENUE, OPA LOCKA, FL, 33054
G19000091082 MEDEXPRESS URGENT CARE-BRANDON EXPIRED 2019-08-23 2024-12-31 No data 408 E.BRANDON BLVD, BRANDON, FL, 33511
G18000116465 MEDEXPRESS URGENT CARE-LAKELAND, N ROAD 98 ACTIVE 2018-10-29 2029-12-31 No data 3700 N. ROAD 98,SUITE 101, LAKELAND, FL, 33809-3863
G18000078540 MEDEXPRESS URGENT CARE-CLEWISTON, W SUGARLAND HWY ACTIVE 2018-07-20 2028-12-31 No data 960 S. WUGARLAND HIGHWAY, CLEWISTON, FL, 33440-2701
G18000015226 MEDEXPRESS URGENT CARE - VERO BEACH, US HIGHWAY 1 ACTIVE 2018-01-29 2029-12-31 No data 1150 US HIGHWAY 1, VERO BEACH, FL, 32960-9992
G17000114218 MEDEXPRESS URGENT CARE - ESTERO, S TAMIAMI TRL EXPIRED 2017-10-17 2022-12-31 No data 19985 SOUTH TAMIAMI TRAIL, ESTERO, FL, 33928-2268
G17000093314 MEDEXPRESS URGENT CARE - JACKSONVILLE, ATLANTIC BLVD. ACTIVE 2017-08-23 2027-12-31 No data 11985 ATLANTIC BLVD., JACKSONVILLE, FL, 32225-2919

Events

Event Type Filed Date Value Description
ADMIN DISSOLUTION FOR ANNUAL REPORT 2024-09-27 No data No data
CHANGE OF PRINCIPAL ADDRESS 2023-07-06 26812 U.S. Highway 19N, Clearwater, FL 33761 No data
AMENDMENT 2022-07-15 No data No data
AMENDMENT 2022-04-26 No data No data
AMENDMENT 2021-11-01 No data No data
AMENDMENT 2021-02-04 No data No data
AMENDMENT 2020-09-01 No data No data
AMENDMENT 2020-08-28 No data No data
CHANGE OF MAILING ADDRESS 2020-05-18 26812 U.S. Highway 19N, Clearwater, FL 33761 No data
AMENDMENT 2019-11-20 No data No data

Debts

Document Number Status Case Number Name of Court Date of Entry Expiration Date Amount Due Plaintiff
J22000040891 TERMINATED 1000000912683 HILLSBOROU 2022-01-13 2032-01-26 $ 895.97 STATE OF FLORIDA, DEPARTMENT OF REVENUE, OUT OF STATE COLLECTIONS UNIT, 1415 W US HIGHWAY 90 STE 115, LAKE CITY FL320556156
J21000030399 TERMINATED 1000000871072 HILLSBOROU 2021-01-13 2031-01-27 $ 584.56 STATE OF FLORIDA, DEPARTMENT OF REVENUE, TAMPA SERVICE CENTER, 5483 W WATERS AVE STE 1210, TAMPA FL336341236

Documents

Name Date
ANNUAL REPORT 2023-04-18
Amendment 2022-07-15
ANNUAL REPORT 2022-04-26
Amendment 2022-04-26
Amendment 2021-11-01
ANNUAL REPORT 2021-04-24
Amendment 2021-02-04
Amendment 2020-09-01
Amendment 2020-08-28
AMENDED ANNUAL REPORT 2020-08-25

Date of last update: 01 Feb 2025

Sources: Florida Department of State