| Entity Name: | JACKSONVILLE HEALTHCARE GROUP INC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 08 Apr 2021 (4 years ago) |
| Date of dissolution: | 03 Feb 2024 (a year ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 03 Feb 2024 (a year ago) |
| Document Number: | P21000034268 |
| FEI/EIN Number | 86-3119410 |
| Address: | 6821 SOUTHPOINT DRIVE N, JACKSONVILLE, FL, 32216, US |
| Mail Address: | 6821 SOUTHPOINT DRIVE N, JACKSONVILLE, FL, 32216, US |
| ZIP code: | 32216 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1841872793 | 2021-04-21 | 2021-10-05 | 6821 SOUTHPOINT DR N STE 107, JACKSONVILLE, FL, 322168026, US | 6821 SOUTHPOINT DR N STE 107, JACKSONVILLE, FL, 322168026, US | |||||||||||||||||||||
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| Phone | +1 866-372-0308 |
| Fax | 8774604651 |
Authorized person
| Name | DIORGI LOPEZ SURI |
| Role | PRESIDENT |
| Phone | 8663720308 |
Taxonomy
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 9000195965 |
| State | CO |
| Name | Role | Address |
|---|---|---|
| LOPEZ SURI DIORGI | Agent | 6821 SOUTHPOINT DRIVE N, JACKSONVILLE, FL, 32216 |
| Name | Role | Address |
|---|---|---|
| LOPEZ SURI DIORGI | President | 6821 SOUTHPOINT DRIVE N, JACKSONVILLE, FL, 32216 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G21000100354 | NATIONAL TELEMEDICINE PROVIDERS | ACTIVE | 2021-08-02 | 2026-12-31 | No data | 6821 SOUTHPOINT DRIVE NORTH, SUITE 107, JACKSONVILLE, FL, 32277 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2024-02-03 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2022-01-31 | 6821 SOUTHPOINT DRIVE N, STE 107, JACKSONVILLE, FL 32216 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-01-31 | 6821 SOUTHPOINT DRIVE N, STE 107, JACKSONVILLE, FL 32216 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2021-09-22 | 6821 SOUTHPOINT DRIVE N, STE 107, JACKSONVILLE, FL 32216 | No data |
| Name | Date |
|---|---|
| VOLUNTARY DISSOLUTION | 2024-02-03 |
| ANNUAL REPORT | 2023-04-23 |
| AMENDED ANNUAL REPORT | 2022-10-23 |
| ANNUAL REPORT | 2022-01-31 |
| Domestic Profit | 2021-04-08 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
