| Entity Name: | LILLY MEDICAL SUPPLY, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 02 Jun 2000 (25 years ago) |
| Date of dissolution: | 23 Sep 2011 (13 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 23 Sep 2011 (13 years ago) |
| Document Number: | P00000053518 |
| FEI/EIN Number | 651013173 |
| Address: | 15185 SW 179 AVE, MIAMI, FL, 33175 |
| Mail Address: | 15185 SW 179 AVE, MIAMI, FL, 33175 |
| ZIP code: | 33175 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1689691420 | 2006-07-17 | 2008-05-20 | 334 E 9TH ST, HIALEAH, FL, 330104216, US | 334 E 9TH ST, HIALEAH, FL, 330104216, US | |||||||||||||||||||||
|
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| Phone | +1 305-882-2704 |
| Fax | 3058822706 |
Authorized person
| Name | MRS. MARIA BERGOLLE |
| Role | PRESIDENT |
| Phone | 7867097475 |
Taxonomy
| Taxonomy Code | 332B00000X - Durable Medical Equipment & Medical Supplies |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 022991100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BERGOLLA MARIA | Agent | 334 EAST 9 STREET, HIALEAH, FL, 33010 |
| Name | Role | Address |
|---|---|---|
| BERGOLLA MARIA | President | 334 E 9 STREET, HIALEAH, FL, 33010 |
| Name | Role | Address |
|---|---|---|
| BERGOLLA MARIA | Director | 334 E 9 STREET, HIALEAH, FL, 33010 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2011-09-23 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2010-03-17 | 15185 SW 179 AVE, MIAMI, FL 33175 | No data |
| CANCEL ADM DISS/REV | 2010-03-17 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2010-03-17 | 15185 SW 179 AVE, MIAMI, FL 33175 | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2009-09-25 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2008-03-13 | 334 EAST 9 STREET, HIALEAH, FL 33010 | No data |
| AMENDMENT | 2000-11-27 | No data | No data |
| AMENDMENT | 2000-09-06 | No data | No data |
| Name | Date |
|---|---|
| REINSTATEMENT | 2010-03-17 |
| ANNUAL REPORT | 2008-03-13 |
| ANNUAL REPORT | 2007-03-29 |
| ANNUAL REPORT | 2006-04-17 |
| ANNUAL REPORT | 2005-03-31 |
| ANNUAL REPORT | 2004-04-19 |
| ANNUAL REPORT | 2003-02-18 |
| ANNUAL REPORT | 2002-04-29 |
| ANNUAL REPORT | 2001-02-13 |
| Amendment | 2000-11-27 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
