| Entity Name: | IMAGES MEDICAL CLINIC PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 05 Oct 2020 (4 years ago) |
| Document Number: | P20000079762 |
| FEI/EIN Number | 85-3476246 |
| Mail Address: | 4312 RUSTIC PINE PL, WESLEY CHAPEL, FL, 33544, US |
| Address: | 38176 Medical Center Ave, ZEPHYRHILLS, FL, 33540, US |
| ZIP code: | 33540 |
| County: | Pasco |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1386247310 | 2020-11-20 | 2023-03-07 | PO BOX 7062, WESLEY CHAPEL, FL, 335450100, US | 38176 MEDICAL CENTER AVE, ZEPHYRHILLS, FL, 335401380, US | |||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||
| Phone | +1 813-444-7311 |
| Fax | 8134880011 |
Authorized person
| Name | KASIE RUSSELL |
| Role | OWNER |
| Phone | 8134447311 |
Taxonomy
| Taxonomy Code | 208D00000X - General Practice Physician |
| Is Primary | No |
| Taxonomy Code | 363LA2200X - Adult Health Nurse Practitioner |
| Is Primary | Yes |
| Taxonomy Code | 363LP2300X - Primary Care Nurse Practitioner |
| Is Primary | No |
Other Provider Identifiers
| Issuer | APRN |
| Number | 9268544 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Russell Katherine L | Agent | 38176 Medical Center Ave, ZEPHYRHILLS, FL, 33540 |
| Name | Role | Address |
|---|---|---|
| RUSSELL VOGT KASIE | President | 4312 RUSTIC PINE PL, WESLEY CHAPEL, FL, 33544 |
| Name | Role | Address |
|---|---|---|
| Vogt Jayson C | Busi | 4312 Rustic Pine Pl, Wesley Chapel, FL, 33544 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G22000137019 | IMAGES MEDICAL CLINIC | ACTIVE | 2022-11-01 | 2027-12-31 | No data | 38176 MEDICAL CENTER AVE, ZEPHYRHILLS, FL, 33540 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2021-01-19 | 38176 Medical Center Ave, ZEPHYRHILLS, FL 33540 | No data |
| REGISTERED AGENT NAME CHANGED | 2021-01-19 | Russell, Katherine Louise | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-01-19 | 38176 Medical Center Ave, ZEPHYRHILLS, FL 33540 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-12 |
| ANNUAL REPORT | 2023-04-04 |
| ANNUAL REPORT | 2022-02-28 |
| ANNUAL REPORT | 2021-01-19 |
| Domestic Profit | 2020-10-05 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
