| Entity Name: | COLUMBIA FAMILY MEDICINE INC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Inactive |
| Date Filed: | 26 Aug 2022 (2 years ago) |
| Date of dissolution: | 27 Sep 2024 (4 months ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 27 Sep 2024 (4 months ago) |
| Document Number: | P22000067364 |
| FEI/EIN Number | 88-3948860 |
| Address: | 238 SW CULLEN AVE, FORT WHITE, FL 32038 |
| Mail Address: | 238 SW CULLEN AVE, FORT WHITE, FL 32038 |
| ZIP code: | 32038 |
| County: | Columbia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1104533173 | 2022-10-31 | 2023-01-23 | 238 SW CULLEN AVE, FORT WHITE, FL, 320383536, US | 238 SW CULLEN AVE, FORT WHITE, FL, 320383536, US | |||||||||||||||
|
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| Phone | +1 386-365-0809 |
| Phone | +1 386-497-1397 |
Authorized person
| Name | DAVID WAYNE DAVIS |
| Role | OWNER |
| Phone | 3863650809 |
Taxonomy
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| DAVIS, DAVID | Agent | 1632 SW OLD WIRE RD, LAKE CITY, FL 32024 |
| Name | Role | Address |
|---|---|---|
| DAVIS, DAVID | President | 1632 SW OLD WIRE RD, LAKE CITY, FL 32024 |
| Name | Role | Address |
|---|---|---|
| DAVIS, CYNTHIA | Vice President | 238 SW CULLEN AVE, FORT WHITE, FL 32038 |
| Name | Role | Address |
|---|---|---|
| HOLMES, HALEY | Secretary | 238 SW CULLEN AVE, FORT WHITE, FL 32038 |
| Name | Role | Address |
|---|---|---|
| HOLMES, HALEY | TREAS | 238 SW CULLEN AVE, FORT WHITE, FL 32038 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2024-09-27 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2023-01-05 | 238 SW CULLEN AVE, FORT WHITE, FL 32038 | No data |
| CHANGE OF MAILING ADDRESS | 2023-01-05 | 238 SW CULLEN AVE, FORT WHITE, FL 32038 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2023-01-05 |
| Domestic Profit | 2022-08-26 |
Date of last update: 11 Jan 2025
Sources: Florida Department of State
