| Entity Name: | SEVEN RIVERS ORTHOPAEDIC & SPORTS MEDICINE, PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 09 Feb 2009 (16 years ago) |
| Date of dissolution: | 28 Sep 2012 (12 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 28 Sep 2012 (12 years ago) |
| Document Number: | P09000012537 |
| FEI/EIN Number | 264218544 |
| Address: | 10495 NORTH FLORIDA AVE, CITRUS SPRINGS, FL, 34434, US |
| Mail Address: | 5558 N. CARNATION DRIVE, BEVERLY HILLS, FL, 34465, US |
| ZIP code: | 34434 |
| County: | Citrus |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1306172259 | 2009-10-28 | 2009-10-28 | PO BOX 640573, BEVERLY HILLS, FL, 344640573, US | 10495 N FLORIDA AVE, CITRUS SPRINGS, FL, 344343268, US | |||||||||||||||||||||
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| Phone | +1 352-465-5663 |
| Fax | 3524655664 |
Authorized person
| Name | DELORES WHITE |
| Role | PRESIDENT |
| Phone | 3522497080 |
Taxonomy
| Taxonomy Code | 207X00000X - Orthopaedic Surgery Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS TN |
| Number | 4111270 |
| State | TN |
| Name | Role | Address |
|---|---|---|
| WHITE DELORES K | Agent | 5558 N. CARNATION DRIVE, BEVERLY HILLS, FL, 34465 |
| Name | Role | Address |
|---|---|---|
| WHITE DELORES K | Director | 5558 N. CARNATION DRIVE, BEVERLY HILLS, FL, 34465 |
| Name | Role | Address |
|---|---|---|
| WHITE DELORES K | President | 5558 N. CARNATION DRIVE, BEVERLY HILLS, FL, 34465 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2012-09-28 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2010-01-08 | 10495 NORTH FLORIDA AVE, CITRUS SPRINGS, FL 34434 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2011-04-20 |
| FEI# | 2010-03-01 |
| ANNUAL REPORT | 2010-01-08 |
| Domestic Profit | 2009-02-09 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
