| Entity Name: | SHARPER IMAGING DIAGNOSTIC RADIOLOGY CENTER, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 23 Jun 2003 (22 years ago) |
| Date of dissolution: | 26 Sep 2014 (10 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 26 Sep 2014 (10 years ago) |
| Document Number: | P03000069410 |
| FEI/EIN Number | 161673147 |
| Mail Address: | C/O DAVID A. HOLMES, 99 NESBIT STREET, PUNTA GORDA, FL, 33950 |
| Address: | 3430 TAMIAMI TRAIL, SUITE B, PORT CHARLOTTE, FL, 33952 |
| ZIP code: | 33952 |
| County: | Charlotte |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1730288515 | 2006-09-21 | 2020-08-22 | 3430 TAMIAMI TRL, SUITE B, PORT CHARLOTTE, FL, 339528127, US | 3430 TAMIAMI TRL, SUITE B, PORT CHARLOTTE, FL, 339528127, US | |||||||||||||||||||||||||||||||
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| Phone | +1 941-883-8383 |
| Fax | 9418838386 |
Authorized person
| Name | KELLY BLACKMER |
| Role | BUSINESS OFFICE MANAGER |
| Phone | 9412763517 |
Taxonomy
| Taxonomy Code | 261QR0200X - Radiology Clinic/Center |
| License Number | ME67871 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | HUMANA |
| Number | 150492200863 |
| Issuer | BCBS |
| Number | V2822 |
| Issuer | AMERIGROUP |
| Number | 213119 |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| HARBOR IMAGING 401(K) PLAN & TRUST | 2011 | 161673147 | 2012-01-27 | SHARPER IMAGING DIAGNOSTIC RADIOLOGY CENTER, INC. | 7 | |||||||||||||||||||||||||||||||||
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| Administrator’s EIN | 161673147 |
| Plan administrator’s name | SHARPER IMAGING DIAGNOSTIC RADIOLOGY CENTER, INC. |
| Plan administrator’s address | 3430 TAMIAMI TRAIL, SUITE B, PORT CHARLOTTE, FL, 339528148 |
| Administrator’s telephone number | 9418838383 |
Signature of
| Role | Plan administrator |
| Date | 2012-01-27 |
| Name of individual signing | JACQUELINE WILLIAMS |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2006-01-01 |
| Business code | 621399 |
| Sponsor’s telephone number | 9418838383 |
| Plan sponsor’s DBA name | D/B/A HARBOR IMAGING |
| Plan sponsor’s address | 3430 TAMIAMI TRAIL, SUITE B, PORT CHARLOTTE, FL, 339528148 |
Plan administrator’s name and address
| Administrator’s EIN | 161673147 |
| Plan administrator’s name | SHARPER IMAGING DIAGNOSTIC RADIOLOGY CENTER, INC. |
| Plan administrator’s address | 3430 TAMIAMI TRAIL, SUITE B, PORT CHARLOTTE, FL, 339528148 |
| Administrator’s telephone number | 9418838383 |
Signature of
| Role | Plan administrator |
| Date | 2011-05-04 |
| Name of individual signing | JACQUELINE WILLIAMS |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| HOLMES DAVID A | Agent | 99 NESBIT STREET, PUNTA GORDA, FL, 33950 |
| Name | Role | Address |
|---|---|---|
| WHITE JAMES E | Director | 3430 TAMIAMI TRAIL, STE B, PORT CHARLOTTE, FL, 33950 |
| Name | Role | Address |
|---|---|---|
| WHITE JAMES E | President | 3430 TAMIAMI TRAIL, STE B, PORT CHARLOTTE, FL, 33950 |
| Name | Role | Address |
|---|---|---|
| WHITE JAMES E | Secretary | 3430 TAMIAMI TRAIL, STE B, PORT CHARLOTTE, FL, 33950 |
| Name | Role | Address |
|---|---|---|
| WHITE JAMES E | Treasurer | 3430 TAMIAMI TRAIL, STE B, PORT CHARLOTTE, FL, 33950 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2014-09-26 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2009-03-19 | 3430 TAMIAMI TRAIL, SUITE B, PORT CHARLOTTE, FL 33952 | No data |
| CANCEL ADM DISS/REV | 2007-10-26 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2007-10-26 | 3430 TAMIAMI TRAIL, SUITE B, PORT CHARLOTTE, FL 33952 | No data |
| REGISTERED AGENT NAME CHANGED | 2007-10-26 | HOLMES, DAVID A | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2007-10-26 | 99 NESBIT STREET, PUNTA GORDA, FL 33950 | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2007-09-14 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2013-04-09 |
| ANNUAL REPORT | 2012-04-29 |
| ANNUAL REPORT | 2011-04-30 |
| ANNUAL REPORT | 2010-05-01 |
| ANNUAL REPORT | 2009-03-19 |
| ANNUAL REPORT | 2008-04-10 |
| REINSTATEMENT | 2007-10-26 |
| ANNUAL REPORT | 2006-04-03 |
| ANNUAL REPORT | 2005-01-27 |
| ANNUAL REPORT | 2004-05-03 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
