| Entity Name: | PHYSICAL HEALTHCARE OF JACKSONVILLE, INC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 28 Dec 2012 (12 years ago) |
| Last Event: | CORPORATE MERGER |
| Event Date Filed: | 19 Oct 2018 (6 years ago) |
| Document Number: | P12000104228 |
| FEI/EIN Number | 461666015 |
| Address: | 12620 BEACH BLVD, Suite 6, JACKSONVILLE, FL, 32246, US |
| Mail Address: | 12620 BEACH BLVD, Suite 6, JACKSONVILLE, FL, 32246, US |
| ZIP code: | 32246 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 1760722011 | 2013-02-25 | 2017-04-18 | 12620 BEACH BLVD, SUITE 6, JACKSONVILLE, FL, 322467131, US | 12620 BEACH BLVD, SUITE 6, JACKSONVILLE, FL, 322467131, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 904-645-0777 |
| Fax | 9046453483 |
Authorized person
| Name | MARK A PIERCE |
| Role | CLINIC DIRECTOR |
| Phone | 9046450777 |
Taxonomy
| Taxonomy Code | 111N00000X - Chiropractor |
| License Number | CH6451 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 111N00000X - Chiropractor |
| License Number | CH6588 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 111N00000X - Chiropractor |
| License Number | CH4435 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | ME55161 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 208100000X - Physical Medicine & Rehabilitation Physician |
| License Number | ME0060908 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 225100000X - Physical Therapist |
| License Number | PT30658 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 332B00000X - Durable Medical Equipment & Medical Supplies |
| License Number | ME0060908 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 332B00000X - Durable Medical Equipment & Medical Supplies |
| License Number | ME55161 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 363AM0700X - Medical Physician Assistant |
| License Number | PA9106788 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 363LF0000X - Family Nurse Practitioner |
| License Number | ARNP 770742 |
| State | FL |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| Farah Law | Agent | 6550 ST. AUGUSTINE ROAD, Jacksonville, FL, 32217 |
| Name | Role | Address |
|---|---|---|
| PIERCE MARK ASR | President | 12620 BEACH BLVD, JACKSONVILLE, FL, 32246 |
| Name | Role | Address |
|---|---|---|
| Pierce Elaine C | Secretary | 12620 BEACH BLVD, JACKSONVILLE, FL, 32246 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G20000154949 | ANODYNE PAIN & WELLNESS OF JACKSONVILLE | ACTIVE | 2020-12-07 | 2025-12-31 | No data | 12620 BEACH BLVD, STE 6, JACKSONVILLE, FL, 32246 |
| G14000099332 | FIT RX | EXPIRED | 2014-09-30 | 2019-12-31 | No data | 12620-7 BEACH BLVD, JACKSONVILLE, FL, 32246 |
| G14000092922 | FIT LIFE AT PHYSICAL HEALTHCARE OF JACKSONVILLE, INC | EXPIRED | 2014-09-11 | 2019-12-31 | No data | 12620-6 BEACH BLVD, JACKSONVILLE, FL, 32246 |
| G14000051697 | NEUROPATHY TREATMENT CENTER AT PHYSICAL HEALTHCARE OF JACKSONVILLE INC | EXPIRED | 2014-05-28 | 2019-12-31 | No data | 12620-6 BEACH BLVD, JACKSONVILLE, FL, 32246 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2023-08-23 | 12620 BEACH BLVD, Suite 6, JACKSONVILLE, FL 32246 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-08-23 | 6550 ST. AUGUSTINE ROAD, Suite 103, Jacksonville, FL 32217 | No data |
| REGISTERED AGENT NAME CHANGED | 2023-08-23 | Farah Law | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2021-03-04 | 12620 BEACH BLVD, Suite 6, JACKSONVILLE, FL 32246 | No data |
| MERGER | 2018-10-19 | No data | CORPORATION WAS A MERGER RESULT. TOTAL NUMBER OF QUALIFIED CORPORATION(S) INVOLVED WAS 1. MERGER NUMBER 900000186199 |
| REINSTATEMENT | 2013-12-09 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2013-09-27 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-04 |
| AMENDED ANNUAL REPORT | 2023-08-23 |
| ANNUAL REPORT | 2023-05-24 |
| ANNUAL REPORT | 2022-02-21 |
| ANNUAL REPORT | 2021-05-19 |
| AMENDED ANNUAL REPORT | 2020-12-04 |
| ANNUAL REPORT | 2020-05-07 |
| ANNUAL REPORT | 2019-03-26 |
| Merger | 2018-10-19 |
| ANNUAL REPORT | 2018-04-25 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 7357738405 | 2021-02-11 | 0491 | PPS | 12620 Beach Blvd Ste 6, Jacksonville, FL, 32246-4152 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 7634027004 | 2020-04-07 | 0491 | PPP | 12620 BEACH BLVD, Suite 6, JACKSONVILLE, FL, 32246-4152 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 03 Feb 2025
Sources: Florida Department of State
