| Entity Name: | JACKSONVILLE MOBILE IMAGING SERVICES, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Inactive |
| Date Filed: | 30 Nov 1992 (32 years ago) |
| Date of dissolution: | 08 Apr 2022 (3 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 08 Apr 2022 (3 years ago) |
| Document Number: | P92000009131 |
| FEI/EIN Number | 59-3151365 |
| Address: | 4237 SALISBURY RD., STE. 306, JACKSONVILLE, FL 32216 |
| Mail Address: | 4237 SALISBURY RD., STE. 306, JACKSONVILLE, FL 32216 |
| ZIP code: | 32216 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1043233380 | 2006-07-26 | 2013-02-12 | 4237 SALISBURY RD, SUITE 306, JACKSONVILLE, FL, 322168029, US | 4237 SALISBURY RD, SUITE 306, JACKSONVILLE, FL, 322168029, US | |||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 904-296-0353 |
| Fax | 9042969403 |
Authorized person
| Name | MR. DAVID JOHNSON |
| Role | PRESIDENT |
| Phone | 9042960353 |
Taxonomy
| Taxonomy Code | 261QR0208X - Mobile Radiology Clinic/Center |
| License Number | HCC3853 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 293D00000X - Physiological Laboratory |
| License Number | HCC3853 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | AVMED |
| Number | PIN#1365 102533 |
| State | FL |
| Issuer | PRINCIPAL |
| Number | 606011 |
| State | FL |
| Issuer | RAILROAD MEDICARE |
| Number | 630000562 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| JOHNSON, DAVID | Agent | 4237 SALISBURY RD., STE. 306, JACKSONVILLE, FL 32216 |
| Name | Role | Address |
|---|---|---|
| JOHNSON, DAVID | President | 1 Key Capri, 105 East Treasure Island, FL 33706 |
| Name | Role | Address |
|---|---|---|
| JOHNSON, DAVID | Treasurer | 1 Key Capri, 105 East Treasure Island, FL 33706 |
| Name | Role | Address |
|---|---|---|
| JOHNSON, DAVID | Director | 1 Key Capri, 105 East Treasure Island, FL 33706 |
| GANN, DAVID E | Director | 1 KEY CAPRI, 101 East TREASURE ISLAND, FL 33706 |
| Name | Role | Address |
|---|---|---|
| GANN, DAVID E | Vice President | 1 KEY CAPRI, 101 East TREASURE ISLAND, FL 33706 |
| Name | Role | Address |
|---|---|---|
| GANN, DAVID E | Secretary | 1 KEY CAPRI, 101 East TREASURE ISLAND, FL 33706 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G95020000169 | FIRST COAST MOBILE IMAGING SERVICES, INC. | ACTIVE | 1995-01-20 | 2025-12-31 | No data | 4237 SALISBURY ROAD, SUITE 306, JACKSONVILLE, FL, 32216 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2022-04-08 | No data | No data |
| REINSTATEMENT | 2018-01-05 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2018-01-05 | JOHNSON, DAVID | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2017-09-22 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 1993-06-21 | 4237 SALISBURY RD., STE. 306, JACKSONVILLE, FL 32216 | No data |
| CHANGE OF MAILING ADDRESS | 1993-06-21 | 4237 SALISBURY RD., STE. 306, JACKSONVILLE, FL 32216 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 1993-06-21 | 4237 SALISBURY RD., STE. 306, JACKSONVILLE, FL 32216 | No data |
| Name | Date |
|---|---|
| VOLUNTARY DISSOLUTION | 2022-04-08 |
| ANNUAL REPORT | 2021-03-31 |
| ANNUAL REPORT | 2020-02-18 |
| ANNUAL REPORT | 2019-04-15 |
| REINSTATEMENT | 2018-01-05 |
| ANNUAL REPORT | 2016-03-10 |
| ANNUAL REPORT | 2015-03-11 |
| ANNUAL REPORT | 2014-02-10 |
| ANNUAL REPORT | 2013-02-26 |
| ANNUAL REPORT | 2012-04-25 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
