| Entity Name: | ADVANCED CLINICAL LABORATORIES, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 10 Apr 2003 (22 years ago) |
| Document Number: | P03000040731 |
| FEI/EIN Number | 161660256 |
| Address: | 3705 S HIGHWAY 27, Clermont, FL, 34711, US |
| Mail Address: | 3705 S HIGHWAY 27, Clermont, FL, 34711, US |
| ZIP code: | 34711 |
| County: | Lake |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1033281324 | 2006-11-14 | 2019-10-07 | 3705 S HWY 27 STE 101, CLERMONT, FL, 347117950, US | 3705 S HWY 27 STE 101, CLERMONT, FL, 347117950, US | |||||||||||||||||||||||||
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| Phone | +1 352-536-9270 |
| Fax | 3525369279 |
Authorized person
| Name | MRS. PATRICIA E OWEN |
| Role | EX DIRECTOR OF ADMINISTRATION |
| Phone | 3525369270 |
Taxonomy
| Taxonomy Code | 291U00000X - Clinical Medical Laboratory |
| License Number | 800018668 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 030774200 |
| State | FL |
| Name | Role |
|---|---|
| WALTERS MCCARTNEY, PLLC | Agent |
| Name | Role | Address |
|---|---|---|
| Santana Davian | President | 3705 S HIGHWAY 27, Clermont, FL, 34711 |
| Name | Role | Address |
|---|---|---|
| Santana Davian | Director | 3705 S HIGHWAY 27, Clermont, FL, 34711 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G16000027851 | VISTA CLINICAL | EXPIRED | 2016-03-16 | 2021-12-31 | No data | 4290 S. HIGHWAY 27, SUITE 201, CLERMONT, FL, 34711 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2024-04-30 | 1401 Town Plaza Ct., STE 1020, Winter Springs, FL 32708 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2019-08-07 | 3705 S HIGHWAY 27, Suite 201, Clermont, FL 34711 | No data |
| CHANGE OF MAILING ADDRESS | 2019-08-07 | 3705 S HIGHWAY 27, Suite 201, Clermont, FL 34711 | No data |
| REGISTERED AGENT NAME CHANGED | 2016-04-18 | Walters McCartney | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-30 |
| ANNUAL REPORT | 2023-04-13 |
| ANNUAL REPORT | 2022-04-21 |
| ANNUAL REPORT | 2021-04-19 |
| ANNUAL REPORT | 2020-05-27 |
| ANNUAL REPORT | 2019-04-26 |
| ANNUAL REPORT | 2018-04-26 |
| ANNUAL REPORT | 2017-04-03 |
| ANNUAL REPORT | 2016-04-18 |
| AMENDED ANNUAL REPORT | 2015-11-23 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
