| Entity Name: | BLUE LAGOON HOSPITALISTS, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 30 Mar 2009 (16 years ago) |
| Last Event: | NAME CHANGE AMENDMENT |
| Event Date Filed: | 03 Apr 2009 (16 years ago) |
| Document Number: | P09000028705 |
| FEI/EIN Number | 264611094 |
| Mail Address: | 265 BROOKVIEW CENTRE WAY, SUITE 203, KNOXVILLE, TN, 37919, US |
| Address: | 1643 NW 136TH AVE, BUILDING H, SUITE 100, Sunrise, FL, 33323, US |
| ZIP code: | 33323 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1356664478 | 2010-03-03 | 2010-03-03 | 14050 NW 14TH ST, SUITE 190, SUNRISE, FL, 333232865, US | 8900 N KENDALL DR, MIAMI, FL, 331762118, US | |||||||||||||||||||||||||||
|
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| Phone | +1 800-424-3672 |
| Fax | 9543773042 |
| Phone | +1 305-596-1960 |
| Fax | 3055985960 |
Authorized person
| Name | DR. STEPHEN G. HOLTZCLAW |
| Role | PRESIDENT |
| Phone | 8004243672 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 208M00000X - Hospitalist Physician |
| Is Primary | Yes |
| Name | Role |
|---|---|
| CORPORATION SERVICE COMPANY | Agent |
| Name | Role | Address |
|---|---|---|
| UPPAL, MD ROHIT | Director | 265 Brookview Centre Way, Suite 203, Knoxville, TN, 37919 |
| Name | Role | Address |
|---|---|---|
| STAIR JOHN R | ASSI | 265 BROOKVIEW CENTRE WAY, SUITE 203, KNOXVILLE, TN, 37919 |
| BARRACK JOHN | ASSI | 265 BROOKVIEW CENTRE WAY, SUITE 203, KNOXVILLE, TN, 37919 |
| Name | Role | Address |
|---|---|---|
| Owens Lara | Assi | 265 BROOKVIEW CENTRE WAY, SUITE 203, KNOXVILLE, TN, 37919 |
| Name | Role | Address |
|---|---|---|
| Corvini Michael | Vice President | 265 BROOKVIEW CENTRE WAY, SUITE 203, KNOXVILLE, TN, 37919 |
| Evans Rob | Vice President | 265 BROOKVIEW CENTRE WAY, SUITE 203, KNOXVILLE, TN, 37919 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2024-04-08 | 1643 NW 136TH AVE, BUILDING H, SUITE 100, Sunrise, FL 33323 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2022-04-12 | 1643 NW 136TH AVE, BUILDING H, SUITE 100, Sunrise, FL 33323 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2013-04-17 | 1201 HAYS STREET, TALLAHASSEE, FL 32301 | No data |
| NAME CHANGE AMENDMENT | 2009-04-03 | BLUE LAGOON HOSPITALISTS, INC. | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-08 |
| ANNUAL REPORT | 2023-04-10 |
| ANNUAL REPORT | 2022-04-12 |
| ANNUAL REPORT | 2021-04-09 |
| ANNUAL REPORT | 2020-06-04 |
| ANNUAL REPORT | 2019-04-10 |
| ANNUAL REPORT | 2018-04-16 |
| ANNUAL REPORT | 2017-04-11 |
| ANNUAL REPORT | 2016-04-21 |
| ANNUAL REPORT | 2015-04-14 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
