| Entity Name: | FIVE POINTS MEDICAL CLINIC, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 22 Oct 1997 (27 years ago) |
| Document Number: | P97000091431 |
| FEI/EIN Number | 593477762 |
| Address: | 2025 PARK STREET, JACKSONVILLE, FL, 32204 |
| Mail Address: | 2025 PARK STREET, JACKSONVILLE, FL, 32204 |
| ZIP code: | 32204 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 1770636565 | 2007-01-18 | 2020-08-22 | 2025 PARK ST, JACKSONVILLE, FL, 322043809, US | 2025 PARK ST, JACKSONVILLE, FL, 322043809, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 904-388-1811 |
| Fax | 9043876091 |
Authorized person
| Name | DR. DANIEL A. DODD |
| Role | CLINIC DIRECTOR |
| Phone | 9043881811 |
Taxonomy
| Taxonomy Code | 111N00000X - Chiropractor |
| License Number | CH0004403 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 111N00000X - Chiropractor |
| License Number | CH0004712 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 207LP2900X - Pain Medicine (Anesthesiology) Physician |
| License Number | ME0050071 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 2083X0100X - Occupational Medicine Physician |
| License Number | ME95788 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 225700000X - Massage Therapist |
| License Number | MA35203 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | BLUE CROSS BLUE SHIELD FL |
| Number | 38262 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| LEWIS DAVID R | Agent | 2468 ATLANTIC BOULEVARD, JACKSONVILLE, FL, 32207 |
| Name | Role | Address |
|---|---|---|
| DODD DANIEL A | Director | 2025 PARK STREET, JACKSONVILLE, FL, 32204 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2010-04-22 | No data | No data |
| REINSTATEMENT | 2002-03-21 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2001-09-21 | No data | No data |
Date of last update: 01 Jan 2025
Sources: Florida Department of State
