| Entity Name: | CYPRESS HEALTH SYSTEMS FLORIDA, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 10 Jul 1998 (27 years ago) |
| Date of dissolution: | 26 Sep 2014 (10 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 26 Sep 2014 (10 years ago) |
| Document Number: | P98000061235 |
| FEI/EIN Number | 752782071 |
| Address: | 125 SW 7TH ST, WILISTON, FL, 32696 |
| Mail Address: | 125 SW 7TH ST, WILISTON, FL, 32696 |
| ZIP code: | 32696 |
| County: | Levy |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1629247259 | 2008-02-28 | 2010-11-23 | 125 SW 7TH STREET, WILLISTON, FL, 326962403, US | 125 SW 7TH ST, WILLISTON, FL, 326962403, US | |||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 352-528-2801 |
| Fax | 3525283824 |
Authorized person
| Name | MR. JERRY E GILLMAN |
| Role | CEO |
| Phone | 3525282801 |
Taxonomy
| Taxonomy Code | 261QR1300X - Rural Health Clinic/Center |
| License Number | 4424 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS |
| Number | 72816 |
| State | FL |
| Issuer | MEDICAID |
| Number | 660137500 |
| State | FL |
| Issuer | BCBS OF FL |
| Number | 332 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| LINDAUER RANDY L | Agent | 125 SW 7TH STREET, WILLISTON, FL, 32696 |
| Name | Role | Address |
|---|---|---|
| LINDAUER RANDY L | President | 125 SW 7TH STREET, WILLISTON, FL, 32696 |
| Name | Role | Address |
|---|---|---|
| KHAN JALIL A | Secretary | 6600 MYRTLE BEACH DR, PLANO, TX, 75093 |
| Name | Role | Address |
|---|---|---|
| KHAN JALIL A | Treasurer | 6600 MYRTLE BEACH DR, PLANO, TX, 75093 |
| Name | Role | Address |
|---|---|---|
| KHAN JALIL A | Director | 6600 MYRTLE BEACH DR, PLANO, TX, 75093 |
| TARIQ MOHAMMAD J | Director | 1850 LAKEPOINTE DR #100, LEWISVILLE, TX, 75057 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G11000071625 | VEIN AND VASCULAR CENTER OF NORTH CENTRAL FLORIDA | EXPIRED | 2011-07-18 | 2016-12-31 | No data | 125 SW S7TH STREET, 125 SW 7TH ST, WILLISTON, FL, 32696 |
| G10000075930 | TRI COUNTY FAMILY HEALTH SERVICES - WIILISTON | EXPIRED | 2010-08-18 | 2015-12-31 | No data | 125 SW 7TH STREET, WILLISTON, FL, 32696-2403, US |
| G10000075931 | TRI COUNTY FAMILY HEALTH SERVICES-CHIEFLAND | EXPIRED | 2010-08-18 | 2015-12-31 | No data | 125 SW 7TH STREET, WILLISTON, FL, 32696-2403 |
| G10000067884 | TRI COUNTY HOSPITAL-WILLISTON | EXPIRED | 2010-07-23 | 2015-12-31 | No data | 125 SW 7TH STREET, WILLISTON, FL, 32696-2403 |
| G10000065234 | TRI COUNTY HOSPITAL | EXPIRED | 2010-07-15 | 2015-12-31 | No data | 125 SW 7TH STREET, WILLISTON, FL, 32696-2403 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2014-09-26 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2013-04-16 | LINDAUER, RANDY L | No data |
| REINSTATEMENT | 2006-03-14 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2005-09-16 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2004-03-25 | 125 SW 7TH STREET, WILLISTON, FL 32696 | No data |
| CHANGE OF MAILING ADDRESS | 2000-01-27 | 125 SW 7TH ST, WILISTON, FL 32696 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2000-01-27 | 125 SW 7TH ST, WILISTON, FL 32696 | No data |
| AMENDMENT | 1998-09-25 | No data | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J12000241201 | LAPSED | 2011-CA-000455 | 8TH JUDICIAL LEVY COUNTY | 2012-02-23 | 2017-03-30 | $78,982.43 | ALLIANCE HEALTHCARE SERVICES, INC., (SEE IMAGE FOR ADDITIONAL CREDITORS), 100 BAYVIEW CIRCLE, STE 400, NEWPORT BEACH, CA 92660 |
| J12000199615 | TERMINATED | 11-2879 SC | COUNTY MARION | 2012-02-22 | 2017-03-20 | $9371.14 | SPECIAL PUBLICATIONS, 743 E FT KING ST, OCALA, FL 34471 |
| J11000333034 | LAPSED | 38-2011-CA-000425 | LEVY CIRCUIT | 2011-01-05 | 2016-05-27 | $27,136.41 | WELLS FARGO FINANCIAL LEASING, INC., 800 WALNUT STREET, DES MOINES, IOWA 50309 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2013-04-16 |
| ANNUAL REPORT | 2012-12-21 |
| ANNUAL REPORT | 2012-12-11 |
| ANNUAL REPORT | 2012-01-25 |
| ANNUAL REPORT | 2011-03-16 |
| ANNUAL REPORT | 2010-09-21 |
| ANNUAL REPORT | 2010-06-23 |
| ANNUAL REPORT | 2009-04-07 |
| ANNUAL REPORT | 2008-03-20 |
| ANNUAL REPORT | 2007-01-19 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
