| Entity Name: | FIRST FAMILY PRACTICE, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 21 Dec 2007 (17 years ago) |
| Date of dissolution: | 25 Sep 2020 (4 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 25 Sep 2020 (4 years ago) |
| Document Number: | P07000133978 |
| FEI/EIN Number | 261610821 |
| Address: | 320 1ST ST S, 200, WINTER HAVEN, FL, 33880, US |
| Mail Address: | 320 1ST ST S, 200, WINTER HAVEN, FL, 33880, US |
| ZIP code: | 33880 |
| County: | Polk |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1518130509 | 2008-04-10 | 2013-10-01 | 320 1ST ST S STE 200, SUITE 200, WINTER HAVEN, FL, 338803501, US | 320 1ST ST S, SUITE 200, WINTER HAVEN, FL, 338803501, US | |||||||||||||||||||||
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| Phone | +1 863-294-6132 |
| Fax | 8632938450 |
Authorized person
| Name | DR. TOMMY L LOUISVILLE |
| Role | MEDICAL DIRECTOR |
| Phone | 8632946132 |
Taxonomy
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | AMERIGROUP |
| Number | 01112353 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| LOUISVILLE TOMMY L | Agent | 1801 Crystal Lake Dr, Lakeland, FL, 33801 |
| Name | Role | Address |
|---|---|---|
| LOUISVILLE TOMMY L | President | 221 OLD SPANISH WAY, WINTER HAVEN, FL, 33884 |
| Name | Role | Address |
|---|---|---|
| LOUISVILLE TOMMY L | Secretary | 221 OLD SPANISH WAY, WINTER HAVEN, FL, 33884 |
| Name | Role | Address |
|---|---|---|
| LOUISVILLE TOMMY L | Treasurer | 221 OLD SPANISH WAY, WINTER HAVEN, FL, 33884 |
| Name | Role | Address |
|---|---|---|
| LOUISVILLE TOMMY L | Director | 221 OLD SPANISH WAY, WINTER HAVEN, FL, 33884 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2020-09-25 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2019-04-26 | 1801 Crystal Lake Dr, 200, Lakeland, FL 33801 | No data |
| REINSTATEMENT | 2013-04-30 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2011-09-23 | No data | No data |
| CANCEL ADM DISS/REV | 2008-11-03 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2008-11-03 | 320 1ST ST S, 200, WINTER HAVEN, FL 33880 | No data |
| CHANGE OF MAILING ADDRESS | 2008-11-03 | 320 1ST ST S, 200, WINTER HAVEN, FL 33880 | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2008-09-26 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2019-04-26 |
| ANNUAL REPORT | 2018-04-26 |
| ANNUAL REPORT | 2017-04-28 |
| ANNUAL REPORT | 2016-04-26 |
| ANNUAL REPORT | 2015-07-28 |
| ANNUAL REPORT | 2014-04-14 |
| REINSTATEMENT | 2013-04-30 |
| ANNUAL REPORT | 2010-04-26 |
| ANNUAL REPORT | 2009-05-01 |
| REINSTATEMENT | 2008-11-03 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
