| Entity Name: | INTERNAL MEDICINE ASSOCIATES OF LAKE COUNTY, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 12 Apr 2000 (25 years ago) |
| Last Event: | CANCEL ADM DISS/REV |
| Event Date Filed: | 05 Oct 2007 (17 years ago) |
| Document Number: | P00000036849 |
| FEI/EIN Number | 651005052 |
| Address: | 801 E. DIXIE AVENUE, LEESBURG, FL, 34748, US |
| Mail Address: | 801 E. DIXIE AVENUE, LEESBURG, FL, 34748, US |
| ZIP code: | 34748 |
| County: | Lake |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1285611210 | 2005-12-30 | 2015-04-02 | 619 W DIXIE AVE, LEESBURG, FL, 347482602, US | 619 W DIXIE AVE, LEESBURG, FL, 347482602, US | |||||||||||||||||||||||||||
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| Phone | +1 352-314-2424 |
| Fax | 3523143010 |
Authorized person
| Name | DR. GREGORY MARK BROWN |
| Role | PRESIDENT |
| Phone | 3523142424 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS OF FLORIDA |
| Number | 45358 |
| State | FL |
| Issuer | MEDICAID |
| Number | 259964300 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BROWN GREGORY MDr. | Agent | 801 E. DIXIE AVENUE, LEESBURG, FL, 34748 |
| Name | Role | Address |
|---|---|---|
| BROWN GREGORY MDr. | President | 801 E. DIXIE AVENUE, LEESBURG, FL, 34748 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2017-04-17 | 801 E. DIXIE AVENUE, SUITE 107A, LEESBURG, FL 34748 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2017-04-17 | 801 E. DIXIE AVENUE, SUITE 107A, LEESBURG, FL 34748 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2017-01-24 | 801 E. DIXIE AVENUE, SUITE 107A, LEESBURG, FL 34748 | No data |
| REGISTERED AGENT NAME CHANGED | 2014-04-21 | BROWN, GREGORY M, Dr. | No data |
| CANCEL ADM DISS/REV | 2007-10-05 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2007-09-14 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-10 |
| ANNUAL REPORT | 2023-01-25 |
| ANNUAL REPORT | 2022-02-16 |
| ANNUAL REPORT | 2021-03-05 |
| ANNUAL REPORT | 2020-04-10 |
| ANNUAL REPORT | 2019-02-28 |
| ANNUAL REPORT | 2018-03-26 |
| ANNUAL REPORT | 2017-04-17 |
| ANNUAL REPORT | 2016-04-18 |
| ANNUAL REPORT | 2015-01-13 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
