| Entity Name: | KEY WEST MEDICAL GROUP, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 26 Sep 2001 (23 years ago) |
| Date of dissolution: | 19 Nov 2015 (9 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 19 Nov 2015 (9 years ago) |
| Document Number: | P01000094940 |
| FEI/EIN Number | 651140859 |
| Address: | 1111 12TH ST,, SUITE 210, KEY WEST, FL, 33040 |
| Mail Address: | 1404 Petronia Street, KEY WEST, FL, 33040, US |
| ZIP code: | 33040 |
| County: | Monroe |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1477605285 | 2007-01-18 | 2011-02-11 | 1111 12TH ST, SUITE210, KEY WEST, FL, 330404088, US | 1111 12TH ST, SUITE210, KEY WEST, FL, 330404088, US | |||||||||||||||||||
|
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| Phone | +1 305-296-2414 |
Authorized person
| Name | MS. LISA LACOVA |
| Role | BILLING MANAGER |
| Phone | 9544261186 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 067849000 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CALLEJA JOHN F | Agent | 1404 Petronia Street, KEY WEST, FL, 33040 |
| Name | Role | Address |
|---|---|---|
| CALLEJA JOHN F | President | 1111 12TH ST, SUITE 210, KEY WEST, FL, 33040 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2015-11-19 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2015-03-27 | 1404 Petronia Street, KEY WEST, FL 33040 | No data |
| CHANGE OF MAILING ADDRESS | 2015-03-27 | 1111 12TH ST,, SUITE 210, KEY WEST, FL 33040 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2012-01-06 | 1111 12TH ST,, SUITE 210, KEY WEST, FL 33040 | No data |
| REGISTERED AGENT NAME CHANGED | 2012-01-06 | CALLEJA, JOHN F | No data |
| CANCEL ADM DISS/REV | 2007-09-12 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2003-09-19 | No data | No data |
| Name | Date |
|---|---|
| VOLUNTARY DISSOLUTION | 2015-11-19 |
| ANNUAL REPORT | 2015-03-27 |
| ANNUAL REPORT | 2014-01-14 |
| ANNUAL REPORT | 2013-04-15 |
| ANNUAL REPORT | 2012-01-06 |
| ANNUAL REPORT | 2011-03-16 |
| ANNUAL REPORT | 2010-04-23 |
| ANNUAL REPORT | 2009-03-26 |
| ANNUAL REPORT | 2008-05-30 |
| REINSTATEMENT | 2007-09-12 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
