| Entity Name: | WESTSIDE MEDICAL CLINIC, PA. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 11 Aug 2003 (22 years ago) |
| Date of dissolution: | 27 Sep 2013 (11 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 27 Sep 2013 (11 years ago) |
| Document Number: | P03000088788 |
| FEI/EIN Number | 562386880 |
| Address: | 5084 W. COLONIAL DRIVE, ORLANDO, FL, 32808 |
| Mail Address: | 5084 WEST COLONIAL DR, ORLANDO, FL, 32808 |
| ZIP code: | 32808 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1619039765 | 2006-12-15 | 2007-10-25 | 5084 W COLONIAL DR, ORLANDO, FL, 328087666, US | 5084 W COLONIAL DR, ORLANDO, FL, 328087666, US | |||||||||||||||||||||||||||||||||||
|
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| Phone | +1 407-822-4739 |
| Fax | 4078224789 |
Authorized person
| Name | ROMAN MOSAI |
| Role | PRESIDENT |
| Phone | 4078224739 |
Taxonomy
| Taxonomy Code | 207P00000X - Emergency Medicine Physician |
| License Number | ME40999 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | ME40999 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | ME40999 |
| State | FL |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| MOSAI ROMAN | Agent | 9112 DOLLANGER CT, ORLANDO, FL, 32819 |
| Name | Role | Address |
|---|---|---|
| MOSAI ROMAN | President | 9112 DOLLANGER CT, ORLANDO, FL, 32819 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2013-09-27 | No data | No data |
| CANCEL ADM DISS/REV | 2010-02-11 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2009-09-25 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2007-05-22 | 5084 W. COLONIAL DRIVE, ORLANDO, FL 32808 | No data |
| CHANGE OF MAILING ADDRESS | 2005-08-03 | 5084 W. COLONIAL DRIVE, ORLANDO, FL 32808 | No data |
| AMENDMENT AND NAME CHANGE | 2004-08-12 | WESTSIDE MEDICAL CLINIC, PA. | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2012-04-30 |
| ANNUAL REPORT | 2011-04-29 |
| REINSTATEMENT | 2010-02-11 |
| ANNUAL REPORT | 2008-04-29 |
| ANNUAL REPORT | 2007-05-22 |
| ANNUAL REPORT | 2006-04-27 |
| ANNUAL REPORT | 2005-08-03 |
| Amendment and Name Change | 2004-08-12 |
| ANNUAL REPORT | 2004-04-16 |
| Domestic Profit | 2003-08-11 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
