| Entity Name: | PHYSICIANS STAT LAB, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 17 Mar 1997 (28 years ago) |
| Last Event: | AMENDED AND RESTATED ARTICLES |
| Event Date Filed: | 05 Jul 2023 (2 years ago) |
| Document Number: | P97000025085 |
| FEI/EIN Number | 593431021 |
| Address: | 4290 S. HWY 27, CLERMONT, FL, 34711, US |
| Mail Address: | 4290 S. HWY 27, CLERMONT, FL, 34711, US |
| ZIP code: | 34711 |
| County: | Lake |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1467464917 | 2006-08-13 | 2023-09-14 | 4290 S HWY 27 STE 204, CLERMONT, FL, 347118066, US | 4290 S HWY 27 STE 204, CLERMONT, FL, 347118066, US | |||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||
| Phone | +1 833-782-8522 |
Authorized person
| Name | FRANCISCO URTEAGA |
| Role | OWNER |
| Phone | 3054969038 |
Taxonomy
| Taxonomy Code | 291U00000X - Clinical Medical Laboratory |
| License Number | L800011974 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 119047100 |
| State | FL |
| Issuer | BCBS |
| Number | L9069 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Cassidy Bernard | Agent | 200 S Andrews Ave, Fort lauderdale, FL, 33301 |
| Name | Role | Address |
|---|---|---|
| URTEAGA FRANCISCO | President | 4290 SOUTH HIGHWAY 27, SUITE 204, CLERMONT, FL, 34711 |
| Name | Role | Address |
|---|---|---|
| URTEAGA FRANCISCO | Secretary | 4290 SOUTH HIGHWAY 27, SUITE 204, CLERMONT, FL, 34711 |
| Name | Role | Address |
|---|---|---|
| URTEAGA FRANCISCO | Treasurer | 4290 SOUTH HIGHWAY 27, SUITE 204, CLERMONT, FL, 34711 |
| Name | Role | Address |
|---|---|---|
| URTEAGA FRANCISCO | Director | 4290 SOUTH HIGHWAY 27, SUITE 204, CLERMONT, FL, 34711 |
| Name | Role | Address |
|---|---|---|
| Lopez Carlos A | Officer | 2662 NW 97th Ave, Doral, FL, 33172 |
| Chamoun Robbie N | Officer | 2662 NW 97TH AVE, DORAL, FL, 33172 |
| Guerra Miguel | Officer | 2662 NW 97TH AVE, DORAL, FL, 33172 |
| Linares Jesus | Officer | 2662 NW 97TH AVE, DORAL, FL, 33172 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G24000003569 | GAMMA DIAGNOSTIC LAB | ACTIVE | 2024-01-05 | 2029-12-31 | No data | GAMMA DIAGNOSTIC LAB, 2662 NW 97TH AVE, DORAL, FL, 33172 |
| G11000099063 | VISTA STAT LAB NEW PORT RICHEY | EXPIRED | 2011-10-07 | 2016-12-31 | No data | 5427 WATER ST, NEW PORT RICHEY, FL, 34652 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2024-01-05 | Cassidy, Bernard | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-01-05 | 200 S Andrews Ave, 900, Fort lauderdale, FL 33301 | No data |
| AMENDED AND RESTATEDARTICLES | 2023-07-05 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2022-04-11 | 4290 S. HWY 27, STE. 204, CLERMONT, FL 34711 | No data |
| CHANGE OF MAILING ADDRESS | 2022-04-11 | 4290 S. HWY 27, STE. 204, CLERMONT, FL 34711 | No data |
| AMENDMENT | 2020-07-06 | No data | No data |
| AMENDMENT | 2011-02-14 | No data | No data |
| AMENDMENT | 2007-11-29 | No data | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J21000635353 | TERMINATED | 2021 CA 7710 | ORANGE CO | 2021-11-29 | 2026-12-10 | $193,759.48 | DANIELS 4 PARTNERS LLC, 5555 S. KIRKLAND RD. SUITE 201, ORLANDO, FLORIDA 32819 |
| J20000399747 | TERMINATED | 1000000869672 | PASCO | 2020-12-04 | 2030-12-09 | $ 964.17 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, HOLIDAY SERVICE CENTER, 5483 W WATERS AVE STE 1210, TAMPA FL336341236 |
| J20000243754 | TERMINATED | 2020CA000911CAAXWS | PASCO COUNTY CIRCUIT COURT | 2020-06-23 | 2025-07-07 | $64,192.62 | PAWNEE LEASING CORPORATION, 3801 AUTOMATION WAY, SUITE 207, FORT COLLINS, CO 80525 |
| J20000112900 | ACTIVE | 2019-CA-756-WS | 6TH JUDICIAL CIRCUIT, PASO | 2020-01-24 | 2025-02-24 | $111,912.29 | JPMORGAN CHASE BANK, N.A., P.O. BOX 29550, PHOENIX, AZ 85038 |
| J19000370914 | LAPSED | 2019 CA 000590 O | ORANGE CO | 2019-05-08 | 2024-05-28 | $45,013.50 | FULCRUM CILNICAL LABRATORIES, INC, 13650 W. COLONIAL DRIVE STE, 170, WINTER GARDEN, FLORIDA 34787 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-05 |
| Amended and Restated Articles | 2023-07-05 |
| ANNUAL REPORT | 2023-04-03 |
| ANNUAL REPORT | 2022-04-11 |
| ANNUAL REPORT | 2021-01-05 |
| Amendment | 2020-07-06 |
| ANNUAL REPORT | 2020-06-30 |
| ANNUAL REPORT | 2019-04-04 |
| ANNUAL REPORT | 2018-04-30 |
| AMENDED ANNUAL REPORT | 2017-10-24 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
