| Entity Name: | DIABETES SUPPLY PROGRAM, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 05 Jul 2006 (19 years ago) |
| Date of dissolution: | 26 Mar 2016 (9 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 26 Mar 2016 (9 years ago) |
| Document Number: | P06000089731 |
| FEI/EIN Number | 205160648 |
| Address: | 5121 BOWDEN ROAD, SUITE 309, JACKSONVILLE, FL, 32216, US |
| Mail Address: | 5121 BOWDEN ROAD, SUITE 309, JACKSONVILLE, FL, 32216, US |
| ZIP code: | 32216 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1457370587 | 2006-07-19 | 2008-09-15 | 5121 BOWDEN RD, SUITE 309, JACKSONVILLE, FL, 322165961, US | 5121 BOWDEN RD, SUITE 309, JACKSONVILLE, FL, 322165961, US | |||||||||||||||||||||||||||
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| Phone | +1 904-367-1694 |
| Fax | 9043678299 |
Authorized person
| Name | MR. SETH R WHITE |
| Role | VICE PRESIDENT |
| Phone | 9043671694 |
Taxonomy
| Taxonomy Code | 332B00000X - Durable Medical Equipment & Medical Supplies |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 116778797A |
| State | GA |
| Issuer | MEDICAID |
| Number | 032429900 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| WHITE WILLIS C | Agent | 5121 BOWDEN ROAD, JACKSONVILLE, FL, 32216 |
| Name | Role | Address |
|---|---|---|
| WHITE SETH R | Treasurer | 531 CANAL RD, PONTE VEDRA BEACH, FL, 32082 |
| Name | Role | Address |
|---|---|---|
| WHITE WILLIS C | President | P. O. BOX 50752, JACKSONVILLE BEACH, FL, 32240 |
| Name | Role | Address |
|---|---|---|
| WHITE SETH R | Secretary | 531 CANAL RD, PONTE VEDRA BEACH, FL, 32082 |
| Name | Role | Address |
|---|---|---|
| WHITE SETH R | Director | 531 CANAL RD, PONTE VEDRA BEACH, FL, 32082 |
| WHITE WILLIS C | Director | P. O. BOX 50752, JACKSONVILLE BEACH, FL, 32240 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G12000034736 | DSP MEDICAL | EXPIRED | 2012-04-11 | 2017-12-31 | No data | 5121 BOWDEN ROAD, SUITE 309, JACKSONVILLE, FL, 32216 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2016-03-26 | No data | No data |
| CANCEL ADM DISS/REV | 2009-11-18 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2009-09-25 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2008-12-01 | 5121 BOWDEN ROAD, SUITE 309, JACKSONVILLE, FL 32216 | No data |
| Name | Date |
|---|---|
| VOLUNTARY DISSOLUTION | 2016-03-26 |
| ANNUAL REPORT | 2015-02-24 |
| ANNUAL REPORT | 2014-03-24 |
| ANNUAL REPORT | 2013-04-13 |
| ANNUAL REPORT | 2012-03-08 |
| ANNUAL REPORT | 2011-02-17 |
| ANNUAL REPORT | 2010-02-24 |
| REINSTATEMENT | 2009-11-18 |
| Reg. Agent Change | 2008-12-01 |
| ANNUAL REPORT | 2008-08-05 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
