| Entity Name: | JOHN R MILES MD PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 26 Jun 2012 (13 years ago) |
| Date of dissolution: | 23 Sep 2022 (2 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 23 Sep 2022 (2 years ago) |
| Document Number: | P12000057260 |
| FEI/EIN Number | 45-5569798 |
| Address: | 402 N DORT ST, PLANT CITY, FL, 33563, US |
| Mail Address: | 402 N DORT ST, PLANT CITY, FL, 33563, US |
| ZIP code: | 33563 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1548651821 | 2015-02-09 | 2015-02-09 | 402 N DORT ST, PLANT CITY, FL, 335634318, US | 402 N DORT ST, PLANT CITY, FL, 335634318, US | |||||||||||||||||||||||||
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| Phone | +1 813-752-3174 |
| Fax | 8136593958 |
Authorized person
| Name | JOHN ROBERT MILES |
| Role | PRESIDENT |
| Phone | 8137523174 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | ME0041517 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 054796400 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Bivins Robert W | Agent | c/o Bivins & Hemenway, P.A., Valrico, FL, 33596 |
| Name | Role | Address |
|---|---|---|
| MILES JOHN RSr. | President | 402 N DORT ST, PLANT CITY, FL, 33563 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2022-09-23 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2018-03-15 | Bivins, Robert W | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2018-03-15 | c/o Bivins & Hemenway, P.A., 1060 Bloomingdale Avenue, Valrico, FL 33596 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2021-04-27 |
| ANNUAL REPORT | 2020-01-23 |
| ANNUAL REPORT | 2019-03-28 |
| ANNUAL REPORT | 2018-03-15 |
| ANNUAL REPORT | 2017-02-14 |
| ANNUAL REPORT | 2016-03-30 |
| ANNUAL REPORT | 2015-01-12 |
| ANNUAL REPORT | 2014-04-04 |
| ANNUAL REPORT | 2013-04-16 |
| Domestic Profit | 2012-06-26 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
