| Entity Name: | DR PATRICK J FULLERTON INC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Inactive |
| Date Filed: | 04 May 2012 (13 years ago) |
| Date of dissolution: | 26 Sep 2014 (10 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 26 Sep 2014 (10 years ago) |
| Document Number: | P12000042165 |
| FEI/EIN Number | 45-5207812 |
| Mail Address: | 5542 BROOKLINE DR, ORLANDO, FL 32819 |
| Address: | 2441 S. Hiawassee Road, Orlando, FL 32835 |
| ZIP code: | 32835 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1962743450 | 2013-03-07 | 2013-07-22 | 2441 S HIAWASSEE RD, ORLANDO, FL, 328356347, US | 2441 S HIAWASSEE RD, ORLANDO, FL, 328356347, US | |||||||||||||||||||||||||||
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| Phone | +1 407-378-6339 |
| Fax | 4073786466 |
| Fax | 4013786466 |
Authorized person
| Name | PATRICK J FULLERTON |
| Role | OWNER |
| Phone | 4077545077 |
Taxonomy
| Taxonomy Code | 261QU0200X - Urgent Care Clinic/Center |
| License Number | OS8087 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 271297100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| JENNELLE, STEPHEN DCPA | Agent | 37009 CALHOUN RD, EUSTIS, FL 32736 |
| Name | Role | Address |
|---|---|---|
| FULLERTON, PATRICK J | President | 5542 BROOKLINE DR, ORLANDO, FL 32819 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G13000002575 | STATMEDX URGENT CARE | EXPIRED | 2013-01-07 | 2018-12-31 | No data | 5542 BROOKLINE DR, ORLANDO, FL, 32819 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2014-09-26 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2013-11-04 | 2441 S. Hiawassee Road, Orlando, FL 32835 | No data |
| REINSTATEMENT | 2013-10-01 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2013-09-27 | No data | No data |
| Name | Date |
|---|---|
| Domestic Profit | 2012-05-04 |
Date of last update: 23 Jan 2025
Sources: Florida Department of State
