| Entity Name: | FLORIDA MEDICAL STAT LABORATORY, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Inactive |
| Date Filed: | 30 Aug 2010 (14 years ago) |
| Date of dissolution: | 22 Sep 2017 (7 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 22 Sep 2017 (7 years ago) |
| Document Number: | P10000071260 |
| FEI/EIN Number | 27-4000636 |
| Address: | 7660 Nob Hill Road, Tamarac, FL 33321 |
| Mail Address: | 7660 Nob Hill Road, Tamarac, FL 33321 |
| ZIP code: | 33321 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1194010058 | 2011-06-17 | 2011-06-17 | 7660 N NOB HILL RD, TAMARAC, FL, 333211843, US | 7660 N NOB HILL RD, TAMARAC, FL, 333211843, US | |||||||||||||||||||||||||||
|
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| Phone | +1 954-933-2439 |
Authorized person
| Name | MR. DAVID STUART GERREN |
| Role | LABORATORY MANAGER |
| Phone | 9549332439 |
Taxonomy
| Taxonomy Code | 291U00000X - Clinical Medical Laboratory |
| Is Primary | No |
| Taxonomy Code | 291U00000X - Clinical Medical Laboratory |
| License Number | NOT ISSUED YET |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | FILE NUMBER FOR AHCA |
| Number | 269842100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| RAZA, MUKHTAR | Agent | 7660 Nob Hill Road, Tamarac, FL 33321 |
| Name | Role | Address |
|---|---|---|
| Raza, Mukhtar | President | 7660 Nob Hill Road, Tamarac, FL 33321 |
| Name | Role | Address |
|---|---|---|
| Raza, Mukhtar | Director | 7660 Nob Hill Road, Tamarac, FL 33321 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G14000105581 | RZA LABORATORY | EXPIRED | 2014-10-17 | 2019-12-31 | No data | 1776 WEST BROWARD BLVD., FT. LAUDERDALE, FL, 33312 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2017-09-22 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2016-01-27 | 7660 Nob Hill Road, Tamarac, FL 33321 | No data |
| REGISTERED AGENT NAME CHANGED | 2016-01-27 | RAZA, MUKHTAR | No data |
| CHANGE OF MAILING ADDRESS | 2015-01-13 | 7660 Nob Hill Road, Tamarac, FL 33321 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2015-01-13 | 7660 Nob Hill Road, Tamarac, FL 33321 | No data |
| AMENDMENT | 2014-08-27 | No data | No data |
| AMENDMENT | 2014-08-25 | No data | No data |
| REINSTATEMENT | 2013-10-10 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2013-09-27 | No data | No data |
| AMENDMENT | 2012-10-19 | No data | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J13000921081 | LAPSED | 13-03361-09 | BROWARD COUNTY CIR CT | 2013-04-03 | 2018-05-20 | $112,609.94 | LABORATORY CORPORATION OF AMERICA, C/O ROBERT E. KORN, ESQ., 2700 N. MILITARY TRAIL, STE. 100, BOCA RATON, FL 33431 |
| J13000556960 | TERMINATED | CACE12-30057 | BROWARD COUNTY CIRCUIT COURT | 2013-03-07 | 2018-03-11 | $24,596.83 | PHYSICIAN SALES AND SERVICE, A SUBSIDIARY OF PSS WORLD, C/O WILLIAM M. LINDEMAN, P.A., P.O. BOX 3506, ORLANDO, FL 32802 |
| J13000443615 | LAPSED | 12-026141 CACE 18 | BROWARD COUNTY | 2013-01-16 | 2018-02-20 | $44,295.65 | HENRY SCHEIN, INC., 135 DURYEA ROAD, MELVILLE, NY 11747-3834 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2016-01-27 |
| ANNUAL REPORT | 2015-01-13 |
| Amendment | 2014-08-27 |
| Amendment | 2014-08-25 |
| ANNUAL REPORT | 2014-01-03 |
| REINSTATEMENT | 2013-10-10 |
| Amendment | 2012-10-19 |
| Amendment | 2012-10-05 |
| Amendment | 2012-06-28 |
| Amendment | 2012-06-20 |
Date of last update: 24 Jan 2025
Sources: Florida Department of State
