| Entity Name: | FLORIDA INSTITUTE OF RESEARCH, MEDICINE, AND SURGERY, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 02 Jun 2000 (25 years ago) |
| Date of dissolution: | 27 Sep 2013 (11 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 27 Sep 2013 (11 years ago) |
| Document Number: | P00000053584 |
| FEI/EIN Number | 593649134 |
| Address: | 70 W GORE ST, SUITE 100, ORLANDO, FL, 32806, US |
| Mail Address: | ATTN: CREDENTIALING DEPARTMENT, 70 W GORE ST, SUITE 100, ORLANDO, FL, 32806, US |
| ZIP code: | 32806 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1053600510 | 2011-04-05 | 2011-04-05 | 70 W. GORE STREET, SUITE 100, CREDENTIALING DEPARTMENT, ORLANDO, FL, 328061124, US | 70 W. GORE STREET, SUITE 100, ORLANDO, FL, 328061124, US | |||||||||||||||||||||||||
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| Phone | +1 407-426-8484 |
| Fax | 4074475229 |
Authorized person
| Name | LEE B CECIL |
| Role | CREDENTIALS/MNGD CARE COORDINATOR |
| Phone | 4074268484 |
Taxonomy
| Taxonomy Code | 207RH0003X - Hematology & Oncology Physician |
| License Number | 601042 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 260147804 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| LAZAR RONALD D | Agent | 70 W GORE ST, ORLANDO, FL, 32806 |
| Name | Role | Address |
|---|---|---|
| FLORES MARIA R | President | 70 W GORE ST, SUITE 100, ORLANDO, FL, 32806 |
| Name | Role | Address |
|---|---|---|
| AKULA GEETHANJALI M | Vice President | 70 W GORE ST, SUITE 100, ORLANDO, FL, 32806 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G08113700033 | UROLOGY CENTRAL OF FLORIDA | EXPIRED | 2008-04-22 | 2013-12-31 | No data | 70 W. GORE STREET, ORLANDO, FL, 32806 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2013-09-27 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2011-03-08 | 70 W GORE ST, SUITE 100, ORLANDO, FL 32806 | No data |
| CHANGE OF MAILING ADDRESS | 2011-03-08 | 70 W GORE ST, SUITE 100, ORLANDO, FL 32806 | No data |
| REGISTERED AGENT NAME CHANGED | 2011-03-08 | LAZAR, RONALD DIR. | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2011-03-08 | 70 W GORE ST, SUITE 100, ORLANDO, FL 32806 | No data |
| NAME CHANGE AMENDMENT | 2007-11-26 | FLORIDA INSTITUTE OF RESEARCH, MEDICINE, AND SURGERY, P.A. | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2012-01-09 |
| ANNUAL REPORT | 2011-03-08 |
| ANNUAL REPORT | 2010-04-01 |
| ANNUAL REPORT | 2009-04-29 |
| ANNUAL REPORT | 2008-03-27 |
| Name Change | 2007-11-26 |
| ANNUAL REPORT | 2007-06-15 |
| ANNUAL REPORT | 2006-07-13 |
| ANNUAL REPORT | 2005-05-02 |
| ANNUAL REPORT | 2004-05-03 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
