| Entity Name: | FLORIDA MED CLINIC OF CLEARWATER, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 16 Dec 2009 (15 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: | P09000100833 |
| FEI/EIN Number | 593381344 |
| Address: | 1840 N. HIGHLAND AVENUE, CLEARWATER, FL, 33755 |
| Mail Address: | 1840 N. HIGHLAND AVENUE, CLEARWATER, FL, 33755 |
| ZIP code: | 33755 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1760712848 | 2010-01-12 | 2010-01-12 | 1840 N HIGHLAND AVE, CLEARWATER, FL, 337552138, US | 1840 N HIGHLAND AVE, CLEARWATER, FL, 337552138, US | |||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 727-442-3001 |
| Fax | 7274679106 |
Authorized person
| Name | DR. ALI SAIFI |
| Role | PRESIDENT |
| Phone | 7274423001 |
Taxonomy
| Taxonomy Code | 152W00000X - Optometrist |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 208100000X - Physical Medicine & Rehabilitation Physician |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 251380300 |
| State | FL |
| Issuer | BLUE SHIELD |
| Number | 40847 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SAIFI ALI | Agent | 1840 N. HIGHLAND AVENUE, CLEARWATER, FL, 33755 |
| Name | Role | Address |
|---|---|---|
| SAIFI ALI | President | 1840 N. HIGHLAND AVENUE, CLEARWATER, FL, 33755 |
| Name | Role | Address |
|---|---|---|
| SAIFI ALI | Secretary | 1840 N. HIGHLAND AVENUE, CLEARWATER, FL, 33755 |
| Name | Role | Address |
|---|---|---|
| SAIFI ALI | Treasurer | 1840 N. HIGHLAND AVENUE, CLEARWATER, FL, 33755 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2012-09-28 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2011-02-24 |
| Domestic Profit | 2009-12-16 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
