| Entity Name: | LAKE NEUROLOGY CLINIC, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Domestic Profit
LAKE NEUROLOGY CLINIC, P.A. is structured as a Domestic Profit Corporation, which, in Florida signifies a Profit Corporation (also known as a C-Corporation). This business structure is recognized as a separate legal entity from its owners. This offers shareholders the benefit of limited liability protection, safeguarding their personal assets from the corporation's debts and obligations, and facilitates raising capital through the issuance of stock. In Florida, Domestic Profit Corporations are governed by Title XXXVI, Chapter 607, Florida Statutes – Florida Business Corporation Act. |
| Status: |
Inactive
The business entity is inactive. This status may signal operational issues or voluntary closure, raising concerns about the business's ability to repay loans and requiring careful risk assessment by lenders. |
| Date Filed: | 10 Jun 2002 (23 years ago) |
| Date of dissolution: | 22 Sep 2017 (8 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 22 Sep 2017 (8 years ago) |
| Document Number: | P02000064029 |
| FEI/EIN Number |
030462195
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 608 A S. 9TH STREET, LEESBURG, FL, 34748 |
| Mail Address: | P.O. BOX 490123, LEESBURG, FL, 34749 |
| ZIP code: | 34748 |
| County: | Lake |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1700958600 | 2006-11-15 | 2010-03-05 | PO BOX 490123, LEESBURG, FL, 347490123, US | 608 S 9TH STREET, STE A, LEESBURG, FL, 34748, US | |||||||||||||||||||||||||||||||||||||
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| Phone | +1 352-360-1122 |
| Fax | 3523601123 |
Authorized person
| Name | MARILYN C GLOVER |
| Role | OFFICE MANAGER |
| Phone | 3523601122 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| License Number | ME76490 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICARE RAILROAD |
| Number | 130025175 |
| State | FL |
| Issuer | BCBS |
| Number | 44751 |
| State | FL |
| Issuer | MEDICAID |
| Number | 257303200 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| PATTERSON-LAKE MARLYN A | President | 608 A S. 9TH STREET, LEESBURG, FL, 34748 |
| PATTERSON-LAKE MARLYN A | Secretary | 608 A S. 9TH STREET, LEESBURG, FL, 34748 |
| PATTERSON-LAKE MARLYN A | Treasurer | 608 A S. 9TH STREET, LEESBURG, FL, 34748 |
| PATTERSON-LAKE MARLYN A | Director | 608 A S. 9TH STREET, LEESBURG, FL, 34748 |
| JOHNSON CHARLES D | Agent | 907 WEBSTER STREET, LEESBURG, FL, 34748 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2017-09-22 | - | - |
| REGISTERED AGENT NAME CHANGED | 2016-03-28 | JOHNSON, CHARLES D | - |
| REINSTATEMENT | 2016-03-28 | - | - |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2012-09-28 | - | - |
| REINSTATEMENT | 2011-10-04 | - | - |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2011-09-23 | - | - |
| CHANGE OF MAILING ADDRESS | 2010-04-30 | 608 A S. 9TH STREET, LEESBURG, FL 34748 | - |
| CHANGE OF PRINCIPAL ADDRESS | 2008-07-29 | 608 A S. 9TH STREET, LEESBURG, FL 34748 | - |
| Name | Date |
|---|---|
| REINSTATEMENT | 2016-03-28 |
| REINSTATEMENT | 2011-10-04 |
| ANNUAL REPORT | 2010-04-30 |
| ANNUAL REPORT | 2009-02-15 |
| ANNUAL REPORT | 2008-07-29 |
| ANNUAL REPORT | 2007-04-10 |
| ANNUAL REPORT | 2006-02-03 |
| ANNUAL REPORT | 2005-01-31 |
| ANNUAL REPORT | 2004-04-04 |
| ANNUAL REPORT | 2003-04-18 |
Date of last update: 03 May 2025
Sources: Florida Department of State
