| Entity Name: | QUIK CLINIC MEDICAL CENTER, INC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 11 Jan 2010 (15 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: | P10000002919 |
| FEI/EIN Number | 271925103 |
| Address: | 4055 N. Andrews Avenue, OAKLAND PARK, FL, 33309, US |
| Mail Address: | PO BOX 14303, FORT LAUDERDALE, FL, 33301 |
| ZIP code: | 33309 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1922320662 | 2010-02-23 | 2019-05-07 | PO BOX 14303, FT LAUDERDALE, FL, 333024303, US | 4055 N ANDREWS AVE, FT LAUDERDALE, FL, 333095269, US | |||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 954-530-9591 |
| Fax | 9545309597 |
Authorized person
| Name | MARIA FREEMAN |
| Role | PRESIDENT |
| Phone | 9545309591 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | ME81857 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 207V00000X - Obstetrics & Gynecology Physician |
| License Number | OS11490 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 363LF0000X - Family Nurse Practitioner |
| License Number | 2904542 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICARE |
| Number | DP610B |
| State | FL |
| Issuer | MEDICAID |
| Number | 002594900 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| FREEMAN MARIA | Agent | 4055 N. Andrews Avenue, OAKLAND PARK, FL, 33309 |
| Name | Role | Address |
|---|---|---|
| FREEMAN MARIA | President | 4055 N. Andrews Avenue, OAKLAND PARK, FL, 33309 |
| Name | Role | Address |
|---|---|---|
| FREEMAN MARIA | Secretary | 4055 N. Andrews Avenue, OAKLAND PARK, FL, 33309 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2020-09-25 | No data | No data |
| REINSTATEMENT | 2018-04-26 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2018-04-26 | 4055 N. Andrews Avenue, OAKLAND PARK, FL 33309 | No data |
| REGISTERED AGENT NAME CHANGED | 2018-04-26 | FREEMAN, MARIA | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2018-04-26 | 4055 N. Andrews Avenue, OAKLAND PARK, FL 33309 | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2017-09-22 | No data | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J17000411266 | LAPSED | CACE-15-003038 | CIRCUIT COURT BROWARD COUNTY | 2017-07-19 | 2022-07-19 | $21,925.72 | DR. CLAUDE L. JONES, 864 N.W. 16 TERRACE, FT. LAUDERDALE, FL 33311 |
| J17000310906 | ACTIVE | 1000000744595 | BROWARD | 2017-05-26 | 2027-06-01 | $ 658.95 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, CORAL SPRINGS SERVICE CENTER, 3301 N UNIVERSITY DR STE 200, CORAL SPRINGS FL330654149 |
| J16000292403 | ACTIVE | 1000000711833 | BROWARD | 2016-04-27 | 2026-05-09 | $ 1,187.55 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, CORAL SPRINGS SERVICE CENTER, 3301 N UNIVERSITY DR STE 200, CORAL SPRINGS FL330654149 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2019-03-14 |
| REINSTATEMENT | 2018-04-26 |
| ANNUAL REPORT | 2016-05-02 |
| ANNUAL REPORT | 2015-05-01 |
| Reg. Agent Resignation | 2015-03-02 |
| Off/Dir Resignation | 2015-02-17 |
| ANNUAL REPORT | 2014-05-01 |
| ANNUAL REPORT | 2013-04-30 |
| ANNUAL REPORT | 2012-04-30 |
| ANNUAL REPORT | 2011-05-01 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
