| Entity Name: | AMERICAN DERMPATH SPECIALISTS, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 12 Feb 2004 (21 years ago) |
| Date of dissolution: | 24 Sep 2010 (14 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 24 Sep 2010 (14 years ago) |
| Document Number: | P04000031467 |
| FEI/EIN Number | 731695788 |
| Address: | 8130 ROYAL PALM BLVD SUITE 201, CORAL SPRINGS, FL, 33065 |
| Mail Address: | 8130 ROYAL PALM BLVD, STE 201, CORAL SPRINGS, FL, 33065 |
| ZIP code: | 33065 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1619080009 | 2006-08-17 | 2008-11-14 | 8130 ROYAL PALM BLVD, SUITE 201, CORAL SPRINGS, FL, 330655703, US | 8130 ROYAL PALM BLVD, SUITE 201, CORAL SPRINGS, FL, 330655703, US | |||||||||||||||||||||||||
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| Phone | +1 954-232-9479 |
| Fax | 9544213201 |
Authorized person
| Name | MRS. MICHELLE SCHLECKER |
| Role | OFFICE MANAGER |
| Phone | 9544213200 |
Taxonomy
| Taxonomy Code | 291U00000X - Clinical Medical Laboratory |
| License Number | 10D1023742 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | L9279 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BADER ROBERT S | Agent | 8190 ROYAL PALM BLVD SUITE 204, CORAL SPRINGS, FL, 33065 |
| Name | Role | Address |
|---|---|---|
| BADER ROBERT S | Director | 8130 ROYAL PALM BLVD SUITE 201, CORAL SPRINGS, FL, 33065 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2010-09-24 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2008-10-01 | 8130 ROYAL PALM BLVD SUITE 201, CORAL SPRINGS, FL 33065 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2008-04-23 | 8130 ROYAL PALM BLVD SUITE 201, CORAL SPRINGS, FL 33065 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2008-04-23 | 8190 ROYAL PALM BLVD SUITE 204, CORAL SPRINGS, FL 33065 | No data |
| NAME CHANGE AMENDMENT | 2004-02-27 | AMERICAN DERMPATH SPECIALISTS, INC. | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2009-03-07 |
| ANNUAL REPORT | 2008-04-23 |
| ANNUAL REPORT | 2007-04-24 |
| ANNUAL REPORT | 2006-04-24 |
| ANNUAL REPORT | 2005-04-29 |
| Name Change | 2004-02-27 |
| Domestic Profit | 2004-02-17 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
