| Entity Name: | PRIME RADIOLOGY OF LEESBURG, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 16 Nov 2015 (9 years ago) |
| Date of dissolution: | 06 Apr 2018 (7 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 06 Apr 2018 (7 years ago) |
| Document Number: | P15000093241 |
| FEI/EIN Number | 47-5585036 |
| Address: | 600 W NORTH BLVD, SUITE E, LEESBURG, FL, 34748, US |
| Mail Address: | 18981 US HWY 441, STE 350 #113, MOUNT DORA, FL, 32757, US |
| ZIP code: | 34748 |
| County: | Lake |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1497202675 | 2016-09-06 | 2016-09-06 | 600 N W BLVD, SUITE E, LEESBURG, FL, 34748, US | 600 N W BLVD, SUITE E, LEESBURG, FL, 34748, US | |||||||||||||||||||
|
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| Phone | +1 863-535-5544 |
| Fax | 3213485777 |
Authorized person
| Name | THOMAS BROWN |
| Role | OWNER |
| Phone | 8635355544 |
Taxonomy
| Taxonomy Code | 2085R0202X - Diagnostic Radiology Physician |
| License Number | ME62144 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| BROWN THOMAS DMD | Agent | 13750 W COLONIAL DRIVE, WINTER GARDEN, FL, 34787 |
| Name | Role | Address |
|---|---|---|
| BROWN THOMAS DMD | President | 13750 W COLONIAL DRIVE, STE 350 #113, WINTER GARDEN, FL, 34787 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G15000117362 | PRIME RADIOLOGY | EXPIRED | 2015-11-18 | 2020-12-31 | No data | 13750 W COLONIAL DRIVE, STE 350 #113, WINTER GARDEN, FL, 34787 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2018-04-06 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2017-08-16 | 600 W NORTH BLVD, SUITE E, LEESBURG, FL 34748 | No data |
| REINSTATEMENT | 2016-10-19 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2016-10-19 | BROWN, THOMAS D, MD | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2016-09-23 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2017-01-18 |
| REINSTATEMENT | 2016-10-19 |
| Domestic Profit | 2015-11-16 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
