| Entity Name: | SOUTH LAKE MEDICINE, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 18 Sep 2002 (22 years ago) |
| Date of dissolution: | 27 Sep 2024 (4 months ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 27 Sep 2024 (4 months ago) |
| Document Number: | P02000101115 |
| FEI/EIN Number | 470888339 |
| Address: | 3190 CITRUS TOWER BLVD., STE. B, CLERMONT, FL, 34711 |
| Mail Address: | 3190 CITRUS TOWER BLVD., STE. B, CLERMONT, FL, 34711 |
| ZIP code: | 34711 |
| County: | Lake |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1699940635 | 2008-04-29 | 2010-07-12 | 3190 CITRUS TOWER BLVD, CLERMONT, FL, 347116802, US | 3190 CITRUS TOWER BLVD, CLERMONT, FL, 347116802, US | |||||||||||||||||||
|
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| Phone | +1 352-242-2282 |
| Fax | 3522422886 |
Authorized person
| Name | DR. HANXIAN HUANG |
| Role | OWNER |
| Phone | 3522422282 |
Taxonomy
| Taxonomy Code | 207QA0505X - Adult Medicine Physician |
| License Number | ME83976 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| WALKER GARY | Agent | 100 S. ASHLEY DRIVE, TAMPA, FL, 33602 |
| Name | Role | Address |
|---|---|---|
| HUANG HANXIAN M | Director | 3190 CITRUS TOWER BLVD, STE B, CLERMONT, FL, 34711 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2024-09-27 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2011-01-09 | 3190 CITRUS TOWER BLVD., STE. B, CLERMONT, FL 34711 | No data |
| CHANGE OF MAILING ADDRESS | 2011-01-09 | 3190 CITRUS TOWER BLVD., STE. B, CLERMONT, FL 34711 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2023-07-14 |
| ANNUAL REPORT | 2022-04-08 |
| ANNUAL REPORT | 2021-03-21 |
| ANNUAL REPORT | 2020-04-30 |
| ANNUAL REPORT | 2019-04-17 |
| ANNUAL REPORT | 2018-03-19 |
| ANNUAL REPORT | 2017-02-21 |
| ANNUAL REPORT | 2016-04-24 |
| ANNUAL REPORT | 2015-03-22 |
| ANNUAL REPORT | 2014-03-30 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
