| Entity Name: | LOGGERHEAD MEDICAL CORP. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Inactive |
| Date Filed: | 29 Jul 2002 (23 years ago) |
| Date of dissolution: | 20 Apr 2006 (19 years ago) |
| Last Event: | CORPORATE MERGER |
| Event Date Filed: | 20 Apr 2006 (19 years ago) |
| Document Number: | P02000081610 |
| FEI/EIN Number | 16-1619180 |
| Address: | 4663 N US HWY 1, MELBOURNE, FL 32935 |
| Mail Address: | 4663 N US HWY 1, MELBOURNE, FL 32935 |
| ZIP code: | 32935 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1023041001 | 2006-07-10 | 2011-09-15 | PO BOX 3123, ST AUGUSTINE, FL, 320853123, US | 307 E NEW HAVEN AVE, MELBOURNE, FL, 329014576, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 904-824-4990 |
| Fax | 9048242226 |
| Phone | +1 321-729-8223 |
| Fax | 3217296252 |
Authorized person
| Name | NANCY L LAYTON |
| Role | OWNER |
| Phone | 3217298223 |
Taxonomy
| Taxonomy Code | 207LP2900X - Pain Medicine (Anesthesiology) Physician |
| License Number | ME51048 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 2081P2900X - Pain Medicine (Physical Medicine & Rehabilitation) Physician |
| License Number | ME105112 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 275274302 |
| State | FL |
| Issuer | BCBS |
| Number | 39339 |
| State | FL |
| Issuer | MEDICAID |
| Number | 275274301 |
| State | FL |
| Issuer | MEDICARE RAILROAD |
| Number | DC0738 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| LAYTON, NANCY | Agent | 4663 N. HARBOR CITY BLVD., MELBOURNE, FL 32935 |
| Name | Role | Address |
|---|---|---|
| LAYTON, NANCY L | President | 4663 N US 1, MELBOURNE, FL 32935 |
| Name | Role | Address |
|---|---|---|
| LAYTON, ANNE | Secretary | 4663 N US HWY 1, MELBOURNE, FL 32935 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| MERGER | 2006-04-20 | No data | CORPORATION WAS PART OF A MERGER. QUALIFIED CORPORATION WAS L06000030910. MERGER NUMBER 100000056721 |
| CHANGE OF PRINCIPAL ADDRESS | 2003-09-15 | 4663 N US HWY 1, MELBOURNE, FL 32935 | No data |
| CHANGE OF MAILING ADDRESS | 2003-09-15 | 4663 N US HWY 1, MELBOURNE, FL 32935 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2006-01-09 |
| ANNUAL REPORT | 2005-02-15 |
| ANNUAL REPORT | 2004-02-08 |
| ANNUAL REPORT | 2003-09-15 |
| Domestic Profit | 2002-07-29 |
Date of last update: 30 Jan 2025
Sources: Florida Department of State
