| Entity Name: | MEDICAL DEPARTMENT STORE AND DISCOUNT UNIFORMS, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 18 Jul 2001 (24 years ago) |
| Document Number: | P01000071420 |
| FEI/EIN Number | 651124407 |
| Address: | COLONIAL BLVD., D-1, FORT MYERS, FL, 33907 |
| Mail Address: | COLONIAL BLVD, FORT MYERS, FL, 33907 |
| ZIP code: | 33907 |
| County: | Lee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1770680993 | 2006-09-20 | 2020-08-22 | PO BOX 07100, FORT MYERS, FL, 339190100, US | 8595 COLLEGE PKWY, FORT MYERS, FL, 339195191, US | |||||||||||||||||||||||||||||
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| Phone | +1 239-274-0304 |
| Fax | 2392740307 |
| Phone | +1 239-482-6111 |
| Fax | 2394826178 |
Authorized person
| Name | MR. JOHN OCASIO |
| Role | PRESIDENT |
| Phone | 2392740304 |
Taxonomy
| Taxonomy Code | 332BX2000X - Oxygen Equipment & Supplies (DME) |
| License Number | 800017 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | R9258 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SMITH WILLIAM R | Agent | 8191 COLLEGE PARKWAY, #204, FORT MYERS, FL, 33912 |
| Name | Role | Address |
|---|---|---|
| OCASIO JOHN | President | 1705 COLONIAL BLVD, FORT MYERS, FL, 33907 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2010-09-24 | No data | No data |
| NAME CHANGE AMENDMENT | 2001-10-05 | MEDICAL DEPARTMENT STORE AND DISCOUNT UNIFORMS, INC. | No data |
Date of last update: 01 Jan 2025
Sources: Florida Department of State
