| Entity Name: | RIDGE MANOR FAMILY CLINIC INC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 11 Dec 1997 (27 years ago) |
| Document Number: | P97000104573 |
| FEI/EIN Number | 593480916 |
| Address: | 12204 CORTEZ BLVD, BROOKSVILLE, FL, 34613, US |
| Mail Address: | POST OFFICE BOX 15781, BROOKSVILLE, FL, 34604, US |
| ZIP code: | 34613 |
| County: | Hernando |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1730577115 | 2015-01-07 | 2015-02-10 | PO BOX 15781, BROOKSVILLE, FL, 346040124, US | 12204 CORTEZ BLVD, BROOKSVILLE, FL, 346132630, US | |||||||||||||||||||
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| Phone | +1 352-799-3449 |
| Fax | 3527993214 |
Authorized person
| Name | DR. GOPAL R KORUPOLU |
| Role | PHYSICIAN/OWNER |
| Phone | 3527993449 |
Taxonomy
| Taxonomy Code | 208D00000X - General Practice Physician |
| License Number | ME0070951 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| KORUPOLU GOPAL R | Agent | 12204 CORTEZ BLVD, BROOKSVILLE, FL, 34613 |
| Name | Role | Address |
|---|---|---|
| KORUPOLU GOPAL R | President | 12204 CORTEZ BLDG-, BROOKSVILLE, FL, 34613 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2012-03-31 | 12204 CORTEZ BLVD, BROOKSVILLE, FL 34613 | No data |
| CHANGE OF MAILING ADDRESS | 2012-03-31 | 12204 CORTEZ BLVD, BROOKSVILLE, FL 34613 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2012-03-31 | 12204 CORTEZ BLVD, BROOKSVILLE, FL 34613 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-14 |
| ANNUAL REPORT | 2023-04-15 |
| ANNUAL REPORT | 2022-03-23 |
| ANNUAL REPORT | 2021-04-30 |
| AMENDED ANNUAL REPORT | 2020-04-07 |
| ANNUAL REPORT | 2020-03-02 |
| ANNUAL REPORT | 2019-03-02 |
| ANNUAL REPORT | 2018-03-10 |
| ANNUAL REPORT | 2017-03-30 |
| ANNUAL REPORT | 2016-03-31 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
