| Entity Name: | CENTERS FOR ADVANCED IMAGING, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 16 May 2002 (23 years ago) |
| Document Number: | P02000055408 |
| FEI/EIN Number | 450478070 |
| Address: | 159 EAST RIVER ROAD, EAST PALATKA, FL, 32131 |
| Mail Address: | PO BOX 838, PALATKA, FL, 32178 |
| ZIP code: | 32131 |
| County: | Putnam |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1851488068 | 2006-10-07 | 2020-08-22 | PO BOX 838, PALATKA, FL, 321780838, US | 3918 CRILL AVENUE, PALATKA, FL, 32178, US | |||||||||||||||||||||||||
|
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| Phone | +1 386-328-3559 |
| Fax | 3863283411 |
Authorized person
| Name | BRENT D BRANDON |
| Role | PRESIDENT OWNER |
| Phone | 3863283559 |
Taxonomy
| Taxonomy Code | 2085R0202X - Diagnostic Radiology Physician |
| License Number | ME68132 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 2644754700 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BRANDON BLAKE K | Agent | 159 EAST RIVER ROAD, EAST PALATKA, FL, 32131 |
| Name | Role | Address |
|---|---|---|
| BRANDON BRENT D | President | 159 EAST RIVER ROAD, EAST PALATKA, FL, 32131 |
| Name | Role | Address |
|---|---|---|
| BRANDON BLAKE K | Vice President | 159 EAST RIVER ROAD, EAST PALATKA, FL, 32131 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2009-09-25 | No data | No data |
| CANCEL ADM DISS/REV | 2006-09-22 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2006-09-15 | No data | No data |
| NAME CHANGE AMENDMENT | 2005-03-01 | CENTERS FOR ADVANCED IMAGING, INC. | No data |
Date of last update: 02 Jan 2025
Sources: Florida Department of State
