| Entity Name: | NORTH CENTRAL MEDICAL CORPORATION, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Inactive |
| Date Filed: | 27 Jan 1997 (28 years ago) |
| Date of dissolution: | 03 Jan 2013 (12 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 03 Jan 2013 (12 years ago) |
| Document Number: | P97000007410 |
| FEI/EIN Number | 59-3422078 |
| Address: | 4001 NEWBERRY ROAD, SUITE A-2, GAINESVILLE, FL 32607 |
| Mail Address: | 4001 NEWBERRY ROAD, SUITE A-2, GAINESVILLE, FL 32607 |
| ZIP code: | 32607 |
| County: | Alachua |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1811975725 | 2006-01-03 | 2009-10-08 | PO BOX 142098, GAINESVILLE, FL, 326142098, US | 4001 NEWBERRY RD, STE A2, GAINESVILLE, FL, 326072358, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 352-373-9656 |
| Fax | 3523744136 |
Authorized person
| Name | MR. JACK B THOMPSON III |
| Role | CEO |
| Phone | 3523739656 |
Taxonomy
| Taxonomy Code | 332B00000X - Durable Medical Equipment & Medical Supplies |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 009930935 |
| State | AL |
| Issuer | MEDICAID |
| Number | 1164348 |
| State | LA |
| Issuer | MEDICAID |
| Number | 7703365 |
| State | NC |
| Issuer | SOUTH CAROLINA MEDICAID P |
| Number | DM1139 |
| State | SC |
| Issuer | MEDICAID |
| Number | 606429698A |
| State | GA |
| Issuer | VIRGINIA MEDICAL ASSISTAN |
| Number | 010070554 |
| State | VA |
| Issuer | MEDICAID |
| Number | 0440757 |
| State | MS |
| Name | Role | Address |
|---|---|---|
| THOMPSON, JACK B | Agent | 4001 NEWBERRY ROAD, SUITE A-2, GAINESVILLE, FL 32607 |
| Name | Role | Address |
|---|---|---|
| NEDER, RONALD A | President | 4001 NEWBERRY ROAD SUITE A-2, GAINESVILLE, FL 32607 |
| Name | Role | Address |
|---|---|---|
| NEDER, RONALD A | Director | 4001 NEWBERRY ROAD SUITE A-2, GAINESVILLE, FL 32607 |
| NEDER, ARLENE S | Director | 11131 NW 11TH AVENUE, GAINESVILLE, FL 32606 |
| Name | Role | Address |
|---|---|---|
| NEDER, ARLENE S | Secretary | 11131 NW 11TH AVENUE, GAINESVILLE, FL 32606 |
| Name | Role | Address |
|---|---|---|
| THOMPSON, JACK B | Chief Executive Officer | 4001 NEWBERRY RD STE A-2, GAINESVILLE, FL 32607 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2013-01-03 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2011-01-03 | 4001 NEWBERRY ROAD, SUITE A-2, GAINESVILLE, FL 32607 | No data |
| REGISTERED AGENT NAME CHANGED | 2009-01-05 | THOMPSON, JACK B | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2009-01-05 | 4001 NEWBERRY ROAD, SUITE A-2, GAINESVILLE, FL 32607 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2001-02-06 | 4001 NEWBERRY ROAD, SUITE A-2, GAINESVILLE, FL 32607 | No data |
| Name | Date |
|---|---|
| VOLUNTARY DISSOLUTION | 2013-01-03 |
| ANNUAL REPORT | 2012-01-03 |
| ANNUAL REPORT | 2011-01-03 |
| ANNUAL REPORT | 2010-01-08 |
| ANNUAL REPORT | 2009-01-05 |
| ANNUAL REPORT | 2008-01-02 |
| ANNUAL REPORT | 2007-01-02 |
| ANNUAL REPORT | 2006-01-04 |
| ANNUAL REPORT | 2005-01-03 |
| ANNUAL REPORT | 2004-01-05 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
