| Entity Name: | RADIOLOGY GROUP OF WEST FLORIDA, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 18 Nov 2003 (21 years ago) |
| Date of dissolution: | 02 Mar 2011 (14 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 02 Mar 2011 (14 years ago) |
| Document Number: | P03000134511 |
| FEI/EIN Number | 200407066 |
| Address: | 2055 NORMANDIE DRIVE, SUITE 108, MONTGOMERY, AL, 36111 |
| Mail Address: | 2055 NORMANDIE DR, SUITE 108, MONTGOMERY, AL, 36111 |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1154378800 | 2006-05-28 | 2008-09-19 | 2055 NORMANDIE DR, SUITE 108, MONTGOMERY, AL, 361112732, US | 8383 N DAVIS HWY, PENSACOLA, FL, 325146039, US | |||||||||||||||||||||
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| Phone | +1 334-288-4624 |
| Fax | 3342803628 |
Authorized person
| Name | MR. MARK D LAURENT |
| Role | COO |
| Phone | 3342884624 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 270015800 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| PIERCE ROBERT A | Agent | 123 SOUTH CALHOUN STREET, TALLAHASSEE, FL, 323011517 |
| Name | Role | Address |
|---|---|---|
| MONTIEL DAVID C | Director | 2055 NORMANDIE DRIVE, STE 108, MONTGOMERY, AL, 36111 |
| MOORE THOMAS S | Director | 2055 NORMANDIE DRIVE, STE 108, MONTGOMERY, AL, 36111 |
| WILLIAMS TERRY D | Director | 2055 NORMANDIE DRIVE, STE 108, MONTGOMERY, AL, 36111 |
| Name | Role | Address |
|---|---|---|
| MONTIEL DAVID C | President | 2055 NORMANDIE DRIVE, STE 108, MONTGOMERY, AL, 36111 |
| Name | Role | Address |
|---|---|---|
| MONTIEL DAVID C | Treasurer | 2055 NORMANDIE DRIVE, STE 108, MONTGOMERY, AL, 36111 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2011-03-02 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2010-08-04 | PIERCE, ROBERT A | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2010-08-04 | 123 SOUTH CALHOUN STREET, TALLAHASSEE, FL 32301-1517 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2010-02-15 | 2055 NORMANDIE DRIVE, SUITE 108, MONTGOMERY, AL 36111 | No data |
| CHANGE OF MAILING ADDRESS | 2006-03-03 | 2055 NORMANDIE DRIVE, SUITE 108, MONTGOMERY, AL 36111 | No data |
| Name | Date |
|---|---|
| Voluntary Dissolution | 2011-03-02 |
| ANNUAL REPORT | 2010-02-15 |
| ANNUAL REPORT | 2009-01-21 |
| ANNUAL REPORT | 2008-07-18 |
| ANNUAL REPORT | 2007-02-05 |
| ANNUAL REPORT | 2006-03-03 |
| ANNUAL REPORT | 2005-05-31 |
| ANNUAL REPORT | 2004-07-19 |
| Domestic Profit | 2003-11-18 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
