| Entity Name: | NORTH FLORIDA MEDICAL CLINIC, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 30 Jun 2005 (20 years ago) |
| Last Event: | CANCEL ADM DISS/REV |
| Event Date Filed: | 09 Oct 2006 (18 years ago) |
| Document Number: | P05000093597 |
| FEI/EIN Number | 203092060 |
| Address: | 1361 13TH AVENUE SOUTH SUITE 150, JACKSONVILLE BEACH, FL, 32250 |
| Mail Address: | 1361 13TH AVENUE SOUTH SUITE 150, JACKSONVILL BEACH, FL, 32250 |
| ZIP code: | 32250 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1639126907 | 2006-05-30 | 2012-01-24 | PO BOX 17809, JACKSONVILLE, FL, 322457809, US | 1361 13TH AVE S STE 150, JACKSONVILLE BEACH, FL, 322503235, US | |||||||||||||||||||||||||||||||||||||||
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| Phone | +1 904-723-0015 |
| Fax | 9043380951 |
| Phone | +1 904-242-7177 |
| Fax | 9042427162 |
Authorized person
| Name | HOLTHAUS KEVIN |
| Role | PRESIDENT |
| Phone | 9042427177 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | ME43785 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS |
| Number | 94954 |
| State | FL |
| Issuer | NPI |
| Number | 1639126907 |
| Issuer | RAILROAD MEDICARE |
| Number | DD6503 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BRENNAN MANNA & DIAMOND PL | Agent | THE SUNTRUST BUILDING, JACKSONVILLE, FL, 32202 |
| Name | Role | Address |
|---|---|---|
| HOLTHAUS KEVIN M | President | 1361 13TH AVENUE SOUTH, SUITE 150, JACKSONVILLE BEACH, FL, 32250 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2011-04-05 | 1361 13TH AVENUE SOUTH SUITE 150, JACKSONVILLE BEACH, FL 32250 | No data |
| CANCEL ADM DISS/REV | 2006-10-09 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2006-10-09 | 1361 13TH AVENUE SOUTH SUITE 150, JACKSONVILLE BEACH, FL 32250 | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2006-09-15 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-21 |
| ANNUAL REPORT | 2023-02-14 |
| ANNUAL REPORT | 2022-03-08 |
| ANNUAL REPORT | 2021-02-10 |
| ANNUAL REPORT | 2020-03-24 |
| ANNUAL REPORT | 2019-05-14 |
| ANNUAL REPORT | 2018-04-24 |
| ANNUAL REPORT | 2017-03-31 |
| ANNUAL REPORT | 2016-04-25 |
| ANNUAL REPORT | 2015-04-14 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
