| Entity Name: | FLORIDA PHYSICIANS MEDICAL GROUP, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Inactive |
| Date Filed: | 21 Nov 2013 (11 years ago) |
| Date of dissolution: | 25 Sep 2015 (9 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 25 Sep 2015 (9 years ago) |
| Document Number: | P13000094747 |
| Address: | 6901 PROFESSIONAL PARKWAY EAST, LAKEWOOD RANCH, FL 34240-8477 |
| Mail Address: | 6901 PROFESSIONAL PARKWAY EAST, LAKEWOOD RANCH, FL 34240-8477 |
| Place of Formation: | FLORIDA |
| Type | Company Name | Company Number | State |
|---|---|---|---|
| Headquarter of | FLORIDA PHYSICIANS MEDICAL GROUP, INC., KENTUCKY | 0516485 | KENTUCKY |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1285662221 | 2006-06-29 | 2008-01-07 | PO BOX 538600, ORLANDO, FL, 328538600, US | 1006 W PLEASANT ST, AVON PARK, FL, 338252966, US | |||||||||||||||||||||||||||
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| Phone | +1 407-200-2700 |
| Fax | 4072004904 |
| Phone | +1 863-453-3121 |
| Fax | 8634522823 |
Authorized person
| Name | BRYAN STILTZ |
| Role | PRESIDENT |
| Phone | 4072002700 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 363AM0700X - Medical Physician Assistant |
| Is Primary | No |
| Name | Role |
|---|---|
| AGENTS AND CORPORATIONS, INC. | Agent |
| Name | Role | Address |
|---|---|---|
| LEE, BRIAN S | Chief Executive Officer | 232 BEARS CLUB DRIVE, JUPITER, FL 33477-4202 |
| Name | Role | Address |
|---|---|---|
| HERNANDEZ, GAYLE G | Secretary | 19556 STERLING BLUFF WAY, BROOKSVILLE, FL 34601-6602 |
| Name | Role | Address |
|---|---|---|
| HERNANDEZ, GAYLE G | Vice President | 19556 STERLING BLUFF WAY, BROOKSVILLE, FL 34601-6602 |
| Name | Role | Address |
|---|---|---|
| WARREN, ALEXANDER S | Director | 941 PONTE VEDRA BOULEVARD, PONTE VEDRA BEACH, FL 32082-3524 |
| RESSINGER, MARK H | Director | 1960 BRIDGEWATER DRIVE, LAKE MARY, FL 32746-6907 |
| MARSH, C. EDWIN | Director | 88 WEST GRAND REGENCY CIRCLE, THE WOODLANDS, TX 77382-1630 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2024-11-12 | 91 NINTH STREET SOUTH, SUITE 330, NAPLES, FL 34102 | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2015-09-25 | No data | No data |
| Name | Date |
|---|---|
| Domestic Profit | 2013-11-21 |
Date of last update: 22 Jan 2025
Sources: Florida Department of State
