| Entity Name: | LAKE BUTLER MEDICAL CLINIC, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 16 Jun 2003 (22 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 23 Aug 2023 (a year ago) |
| Document Number: | P03000068048 |
| FEI/EIN Number | 54-2118362 |
| Mail Address: | PO BOX 188, LAKE BUTLER, FL 32054 |
| Address: | 675 EAST MAIN STREET, LAKE BUTLER, FL 32054 |
| ZIP code: | 32054 |
| County: | Union |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1871582296 | 2005-10-18 | 2010-06-29 | PO BOX 188, LAKE BUTLER, FL, 320540188, US | 675 E MAIN ST, LAKE BUTLER, FL, 320541352, US | |||||||||||||||||||||||||
|
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| Phone | +1 386-496-1328 |
| Fax | 3864962227 |
Authorized person
| Name | MARTHA REGINA LLOYD |
| Role | PHYSICIAN |
| Phone | 3864961328 |
Taxonomy
| Taxonomy Code | 261Q00000X - Clinic/Center |
| License Number | ME81421 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 266578600 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| LLOYD, MARTHA | Agent | 605 NE 1ST STREET, LAKE BUTLER, FL 32054 |
| Name | Role | Address |
|---|---|---|
| LLOYD, MARTHA | President | 605 NE 1ST STREET, LAKE BUTLER, FL 32054 |
| Name | Role | Address |
|---|---|---|
| LLOYD, MARTHA | Director | 605 NE 1ST STREET, LAKE BUTLER, FL 32054 |
| Name | Role | Address |
|---|---|---|
| LLOYD, MARTHA | Vice President | 605 NE 1ST STREET, LAKE BUTLER, FL 32054 |
| Name | Role | Address |
|---|---|---|
| LLOYD, MARTHA | Secretary | 605 NE 1ST STREET, LAKE BUTLER, FL 32054 |
| Name | Role | Address |
|---|---|---|
| LLOYD, MARTHA | Treasurer | 605 NE 1ST STREET, LAKE BUTLER, FL 32054 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2023-08-23 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2023-08-23 | LLOYD, MARTHA | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2022-09-23 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2012-05-01 | 605 NE 1ST STREET, LAKE BUTLER, FL 32054 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2005-02-25 | 675 EAST MAIN STREET, LAKE BUTLER, FL 32054 | No data |
| CHANGE OF MAILING ADDRESS | 2005-02-25 | 675 EAST MAIN STREET, LAKE BUTLER, FL 32054 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-30 |
| REINSTATEMENT | 2023-08-23 |
| ANNUAL REPORT | 2021-04-09 |
| ANNUAL REPORT | 2020-06-29 |
| ANNUAL REPORT | 2019-04-30 |
| ANNUAL REPORT | 2018-04-29 |
| ANNUAL REPORT | 2017-04-28 |
| ANNUAL REPORT | 2016-04-29 |
| ANNUAL REPORT | 2015-04-30 |
| ANNUAL REPORT | 2014-05-01 |
Date of last update: 06 Jan 2025
Sources: Florida Department of State
