| Entity Name: | FORT LAUDERDALE MOBILE ULTRASOUND, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 25 Jun 1997 (28 years ago) |
| Document Number: | P97000056006 |
| FEI/EIN Number | 650763153 |
| Mail Address: | 102 NE 2nd St, Boca Raton, FL, 33432, US |
| Address: | 7301 N.W. 4TH ST., STE 107, PLANTATION, FL, 33317, US |
| ZIP code: | 33317 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1467487066 | 2006-07-11 | 2010-11-15 | PO BOX 5286, FT LAUDERDALE, FL, 333105286, US | 7301 NW 4TH ST, SUITE 107, PLANTATION, FL, 333172234, US | |||||||||||||||||||||||||||||||||||
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| Phone | +1 954-566-4551 |
| Fax | 9545664565 |
Authorized person
| Name | MR. HOWARD S DEKKERS |
| Role | CEO |
| Phone | 9545664551 |
Taxonomy
| Taxonomy Code | 261QM1200X - Magnetic Resonance Imaging (MRI) Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 261QR0200X - Radiology Clinic/Center |
| Is Primary | Yes |
| Taxonomy Code | 261QR0208X - Mobile Radiology Clinic/Center |
| Is Primary | No |
Other Provider Identifiers
| Issuer | AETNA |
| Number | 0889591 |
| State | FL |
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | V2156 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| DEKKERS HOWARD | Agent | 102 NE 2ND ST #151, BOCA RATON, FL, 33432 |
| Name | Role | Address |
|---|---|---|
| DEKKERS HOWARD | Chief Executive Officer | 102 NE 2nd St, Boca Raton, FL, 33432 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2019-10-02 | DEKKERS, HOWARD | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2019-10-02 | 102 NE 2ND ST #151, BOCA RATON, FL 33432 | No data |
| CHANGE OF MAILING ADDRESS | 2019-04-05 | 7301 N.W. 4TH ST., STE 107, PLANTATION, FL 33317 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2010-08-16 | 7301 N.W. 4TH ST., STE 107, PLANTATION, FL 33317 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-28 |
| ANNUAL REPORT | 2023-04-25 |
| ANNUAL REPORT | 2022-04-06 |
| ANNUAL REPORT | 2021-04-20 |
| ANNUAL REPORT | 2020-01-16 |
| Reg. Agent Change | 2019-10-02 |
| ANNUAL REPORT | 2019-04-05 |
| ANNUAL REPORT | 2018-01-16 |
| ANNUAL REPORT | 2017-01-12 |
| ANNUAL REPORT | 2016-01-28 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
