| Entity Name: | MERCY PHYSICIAN GROUP, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 26 May 2005 (20 years ago) |
| Date of dissolution: | 29 Mar 2012 (13 years ago) |
| Last Event: | CORPORATE MERGER |
| Event Date Filed: | 29 Mar 2012 (13 years ago) |
| Document Number: | P05000077111 |
| FEI/EIN Number | 202970015 |
| Address: | 4725 NORTH FEDERAL HIGHWAY, FORT LAUDERDALE, FL, 33308 |
| Mail Address: | 4725 NORTH FEDERAL HIGHWAY, FORT LAUDERDALE, FL, 33308 |
| ZIP code: | 33308 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1285743088 | 2006-08-29 | 2020-08-22 | 3661 S MIAMI AVE, SUITE 310, MIAMI, FL, 331334236, US | 3661 S MIAMI AVE, SUITE 301, MIAMI, FL, 331334236, US | |||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||
| Phone | +1 305-285-1017 |
| Fax | 8666524157 |
| Phone | +1 305-285-5090 |
Authorized person
| Name | MR. JOHN MATUSKA |
| Role | CEO |
| Phone | 3058544400 |
Taxonomy
| Taxonomy Code | 207XX0005X - Sports Medicine (Orthopaedic Surgery) Physician |
| License Number | ME93096 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 208600000X - Surgery Physician |
| Is Primary | No |
| Taxonomy Code | 208C00000X - Colon & Rectal Surgery Physician |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| WEBBER DALE S | Agent | 401 E. JACKSON ST., STE. 2500, TAMPA, FL, 33602 |
| Name | Role | Address |
|---|---|---|
| JOHNSON JOHN C | Chairman | 4725 NORTH FEDERAL HIGHWAY, FORT LAUDERDALE, FL, 33308 |
| Name | Role | Address |
|---|---|---|
| JOHNSON JOHN C | President | 4725 NORTH FEDERAL HIGHWAY, FORT LAUDERDALE, FL, 33308 |
| Name | Role | Address |
|---|---|---|
| JOHNSON JOHN C | Director | 4725 NORTH FEDERAL HIGHWAY, FORT LAUDERDALE, FL, 33308 |
| WILFORD LINDA V | Director | 4725 NORTH FEDERAL HIGHWAY, FORT LAUDERDALE, FL, 33308 |
| WORLEY SR. ELIZABETH S | Director | 9401 BISCAYNE BLVD., MIAMI SHORES, FL, 33138 |
| FITZGERALD J P | Director | 110 MERRICK WAY, SUITE 3B, CORAL GABLES, FL, 33131 |
| MARIN TOMAS M | Director | 5400 SW 102 AVE, MIAMI, FL, 33165 |
| Name | Role | Address |
|---|---|---|
| WILFORD LINDA V | Treasurer | 4725 NORTH FEDERAL HIGHWAY, FORT LAUDERDALE, FL, 33308 |
| Name | Role | Address |
|---|---|---|
| WORLEY SR. ELIZABETH S | Secretary | 9401 BISCAYNE BLVD., MIAMI SHORES, FL, 33138 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| MERGER | 2012-03-29 | No data | CORPORATION WAS PART OF A MERGER. QUALIFIED CORPORATION WAS 705193. MERGER NUMBER 700000121447 |
| AMENDMENT | 2011-07-20 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2011-07-20 | 4725 NORTH FEDERAL HIGHWAY, FORT LAUDERDALE, FL 33308 | No data |
| CHANGE OF MAILING ADDRESS | 2011-07-20 | 4725 NORTH FEDERAL HIGHWAY, FORT LAUDERDALE, FL 33308 | No data |
| REGISTERED AGENT NAME CHANGED | 2011-07-20 | WEBBER, DALE S | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2011-07-20 | 401 E. JACKSON ST., STE. 2500, TAMPA, FL 33602 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2012-02-01 |
| Amendment | 2011-07-20 |
| ANNUAL REPORT | 2011-04-11 |
| ANNUAL REPORT | 2010-03-03 |
| ANNUAL REPORT | 2009-02-13 |
| ANNUAL REPORT | 2008-02-04 |
| ANNUAL REPORT | 2007-02-23 |
| ANNUAL REPORT | 2006-01-31 |
| Domestic Profit | 2005-05-26 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
