| Entity Name: | PROMED WALK-IN CLINIC, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 04 Oct 2000 (24 years ago) |
| Last Event: | NAME CHANGE AMENDMENT |
| Event Date Filed: | 24 Oct 2000 (24 years ago) |
| Document Number: | P00000094139 |
| FEI/EIN Number | 65-1050474 |
| Address: | 15425 Old Jenny Lind Loop, Fort Smith, AR, 72916, US |
| Mail Address: | P. O. Box 10082, Fort Smith, AR, 72917, US |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1467631861 | 2007-11-01 | 2007-11-01 | 1703 SW 2ND AVE, OKEECHOBEE, FL, 349746169, US | 1703 SW 2ND AVE, OKEECHOBEE, FL, 349746169, US | |||||||||||||||||||||||||||||
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| Phone | +1 863-467-7377 |
Authorized person
| Name | CAROL LYNN JOHNS |
| Role | PRESIDENT |
| Phone | 8634677377 |
Taxonomy
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| License Number | ARNP3141172 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICARE |
| Number | Y9729Z |
| State | FL |
| Issuer | BLUE CROSS BLUE SHIELD FL |
| Number | Y9729 |
| State | FL |
| Name | Role |
|---|---|
| REGISTERED AGENTS INC | Agent |
| Name | Role | Address |
|---|---|---|
| Cook Roger | President | 7901 4th St N STE 300, St. Petersburg, FL, 33702 |
| Name | Role | Address |
|---|---|---|
| Collins Michael | Secretary | 7901 4th St N STE 300, St. Petersburg, FL, 33702 |
| Name | Role | Address |
|---|---|---|
| Collins Michael | Treasurer | 7901 4th St N STE 300, St. Petersburg, FL, 33702 |
| Name | Role | Address |
|---|---|---|
| Collins Michael | Director | 7901 4th St N STE 300, St. Petersburg, FL, 33702 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-02-07 | 15425 Old Jenny Lind Loop, Fort Smith, AR 72916 | No data |
| CHANGE OF MAILING ADDRESS | 2024-02-07 | 15425 Old Jenny Lind Loop, Fort Smith, AR 72916 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-02-07 | 7901 4th St N STE 300, St. Petersburg, FL 33702 | No data |
| REGISTERED AGENT NAME CHANGED | 2017-01-03 | Registered Agents Inc | No data |
| NAME CHANGE AMENDMENT | 2000-10-24 | PROMED WALK-IN CLINIC, INC. | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-07 |
| ANNUAL REPORT | 2023-02-06 |
| ANNUAL REPORT | 2022-02-16 |
| ANNUAL REPORT | 2021-03-03 |
| ANNUAL REPORT | 2020-04-07 |
| ANNUAL REPORT | 2019-04-05 |
| ANNUAL REPORT | 2018-01-14 |
| ANNUAL REPORT | 2017-01-03 |
| ANNUAL REPORT | 2016-04-15 |
| ANNUAL REPORT | 2015-04-24 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
