| Entity Name: | FAMILY MEDICAL CARE OF MOUNT DORA, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 26 Dec 2012 (12 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 22 May 2017 (8 years ago) |
| Document Number: | P12000103591 |
| FEI/EIN Number | 46-1785485 |
| Address: | 1502 N. Donnelly Street, MOUNT DORA, FL, 32757, US |
| Mail Address: | 1502 N. Donnelly Street, MOUNT DORA, FL, 32757, US |
| ZIP code: | 32757 |
| County: | Lake |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1265844757 | 2014-06-02 | 2015-01-30 | PO BOX 1844, MOUNT DORA, FL, 327561844, US | 17580 US HIGHWAY 441, MOUNT DORA, FL, 327576711, US | |||||||||||||||||
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| Phone | +1 352-383-8200 |
Authorized person
| Name | JOHN N BOUCHER |
| Role | CEO |
| Phone | 4078347800 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | HCC10266 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| HALL-INGALLS GINA | Agent | 1502 N. Donnelly Street, MOUNT DORA, FL, 32757 |
| Name | Role | Address |
|---|---|---|
| HALL-INGALLS GINA | President | 1502 N. Donnelly Street, MOUNT DORA, FL, 32757 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2018-03-26 | 1502 N. Donnelly Street, Suite 107, MOUNT DORA, FL 32757 | No data |
| CHANGE OF MAILING ADDRESS | 2018-03-26 | 1502 N. Donnelly Street, Suite 107, MOUNT DORA, FL 32757 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2018-03-26 | 1502 N. Donnelly Street, Suite 107, MOUNT DORA, FL 32757 | No data |
| AMENDMENT | 2017-05-22 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2017-05-22 | HALL-INGALLS, GINA | No data |
| AMENDMENT | 2013-02-20 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-05-01 |
| ANNUAL REPORT | 2023-04-28 |
| ANNUAL REPORT | 2022-03-08 |
| ANNUAL REPORT | 2021-01-29 |
| ANNUAL REPORT | 2020-04-03 |
| ANNUAL REPORT | 2019-04-26 |
| ANNUAL REPORT | 2018-03-26 |
| Amendment | 2017-05-22 |
| ANNUAL REPORT | 2017-02-01 |
| ANNUAL REPORT | 2016-01-21 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
