| Entity Name: | PATRICK J. HARRIS, D.O., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 01 Oct 2001 (23 years ago) |
| Date of dissolution: | 24 Sep 2021 (3 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 24 Sep 2021 (3 years ago) |
| Document Number: | P01000096384 |
| FEI/EIN Number | 593747307 |
| Address: | 200 Mission Rd, PALATKA, FL, 32177, US |
| Mail Address: | PO BOX 813, PALATKA, FL, 32177, US |
| ZIP code: | 32177 |
| County: | Putnam |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1689769853 | 2006-10-04 | 2010-09-08 | PO BOX 813, PALATKA, FL, 321780813, US | 200 MISSION RD, PALATKA, FL, 321772618, US | |||||||||||||||||||||||||
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| Phone | +1 386-328-2222 |
| Fax | 3863282238 |
Authorized person
| Name | MR. PATRICK J HARRIS |
| Role | OWNER |
| Phone | 3863282222 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | OS-0008101 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 2600269-00 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| HARRIS PATRICK JDO | Agent | 200 MISSION ROAD, PALATKA, FL, 32177 |
| Name | Role | Address |
|---|---|---|
| HARRIS PATRICK JDO | President | 200 MISSION ROAD, PALATKA, FL, 32177 |
| Name | Role | Address |
|---|---|---|
| HARRIS PATRICK JDO | Secretary | 200 MISSION ROAD, PALATKA, FL, 32177 |
| Name | Role | Address |
|---|---|---|
| HARRIS PATRICK JDO | Director | 200 MISSION ROAD, PALATKA, FL, 32177 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2021-09-24 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2018-03-26 | HARRIS, PATRICK J, DO | No data |
| CHANGE OF MAILING ADDRESS | 2018-03-26 | 200 Mission Rd, PALATKA, FL 32177 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2018-03-26 | 200 Mission Rd, PALATKA, FL 32177 | No data |
| CANCEL ADM DISS/REV | 2010-02-01 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2009-09-25 | No data | No data |
| CANCEL ADM DISS/REV | 2008-10-28 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2008-09-26 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2007-04-23 | 200 MISSION ROAD, PALATKA, FL 32177 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2020-06-29 |
| ANNUAL REPORT | 2019-04-19 |
| ANNUAL REPORT | 2018-03-26 |
| ANNUAL REPORT | 2017-04-25 |
| ANNUAL REPORT | 2016-03-11 |
| ANNUAL REPORT | 2015-02-25 |
| ANNUAL REPORT | 2014-04-07 |
| ANNUAL REPORT | 2013-01-22 |
| ANNUAL REPORT | 2012-01-10 |
| ANNUAL REPORT | 2011-01-03 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
