| Entity Name: | ORIGINS FAMILY MEDICAL AND WEIGHT LOSS CLINIC, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 22 May 2013 (12 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 26 Jan 2021 (4 years ago) |
| Document Number: | P13000046021 |
| FEI/EIN Number | 46-2877406 |
| Address: | 194 SW Wall Terrace, LAKE CITY, FL, 32025, US |
| Mail Address: | 597 NW FAIRWAY DR, LAKE CITY, FL, 32055, US |
| ZIP code: | 32025 |
| County: | Columbia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1962835306 | 2013-08-20 | 2013-09-12 | 194 SW WALL TER, LAKE CITY, FL, 320255086, US | 206 S MARION AVE, LAKE CITY, FL, 320257058, US | |||||||||||||||||||
|
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| Phone | +1 386-719-9227 |
| Fax | 3867199488 |
| Phone | +1 386-755-5014 |
| Fax | 3867553093 |
Authorized person
| Name | MR. DUANE E. THOMAS |
| Role | PRESIDENT/DIRECTOR |
| Phone | 3867555014 |
Taxonomy
| Taxonomy Code | 208D00000X - General Practice Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| IZEIYAMU OSAYANDE S | Agent | 597 NW FAIRWAY DR, LAKE CITY, FL, 32055 |
| Name | Role | Address |
|---|---|---|
| IZEIYAMU OSAYANDE S | President | 597 NW FAIRWAY DR, LAKE CITY, FL, 32055 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2021-01-26 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2021-01-26 | IZEIYAMU, OSAYANDE S | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2020-09-25 | No data | No data |
| AMENDMENT | 2019-10-23 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2019-10-23 | 194 SW Wall Terrace, LAKE CITY, FL 32025 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2014-01-13 | 194 SW Wall Terrace, LAKE CITY, FL 32025 | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J22000402810 | TERMINATED | 1000000931497 | COLUMBIA | 2022-08-17 | 2032-08-23 | $ 564.02 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, ALACHUA SERVICE CENTER, 14107 NW US HWY 441 STE 100, ALACHUA FL326156390 |
| J19000460327 | TERMINATED | 1000000831662 | COLUMBIA | 2019-06-27 | 2029-07-03 | $ 435.76 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, ALACHUA SERVICE CENTER, 14107 NW US HWY 441 STE 100, ALACHUA FL326156390 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-07 |
| ANNUAL REPORT | 2023-04-14 |
| ANNUAL REPORT | 2022-03-11 |
| REINSTATEMENT | 2021-01-26 |
| Amendment | 2019-10-23 |
| ANNUAL REPORT | 2019-02-05 |
| ANNUAL REPORT | 2018-02-06 |
| ANNUAL REPORT | 2017-01-09 |
| ANNUAL REPORT | 2016-03-02 |
| ANNUAL REPORT | 2015-01-08 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
