| Entity Name: | SOUTHERN OPEN MRI, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 04 Sep 1998 (26 years ago) |
| Document Number: | P98000076684 |
| FEI/EIN Number | 593529628 |
| Address: | 289 SW STONEGATE TERRACE, SUITE # 102, LAKE CITY, FL, 32024, US |
| Mail Address: | 289 SW STONEGATE TERRACE, SUITE # 102, LAKE CITY, FL, 32024, US |
| ZIP code: | 32024 |
| County: | Columbia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1194795658 | 2006-01-25 | 2008-02-19 | 289 SW STONEGATE TER, SUITE 102, LAKE CITY, FL, 320243456, US | 289 SW STONEGATE TER, SUITE 102, LAKE CITY, FL, 320243456, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 386-755-4788 |
| Fax | 3867559980 |
Authorized person
| Name | MRS. LUCIA M DELAUZ-SAMI |
| Role | VP/CEO/MANAGER |
| Phone | 3867554788 |
Taxonomy
| Taxonomy Code | 2471C3401X - Computed Tomography Radiologic Technologist |
| Is Primary | No |
| Taxonomy Code | 2471M1202X - Magnetic Resonance Imaging Radiologic Technologist |
| Is Primary | Yes |
| Taxonomy Code | 2471S1302X - Sonography Radiologic Technologist |
| Is Primary | No |
Other Provider Identifiers
| Issuer | AETNA PROVIDER NUMBER |
| Number | 5259706 |
| State | FL |
| Issuer | VISTA HEALTH PLAN |
| Number | B796 |
| State | FL |
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | V2546 |
| State | FL |
| Issuer | FIRST HEALTH PROVIDER NUM |
| Number | 1736853 |
| State | FL |
| Issuer | AVMED PROVIDER NUMBER |
| Number | 271288 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| DELAUZ-SAMI LUCIA | Agent | 207 NW LAKE VALLEY TER, LAKE CITY, FL, 32055 |
| Name | Role | Address |
|---|---|---|
| CALABRESE EUGENE | President | 540 DOUGLAS AVE., ALTAMONTE SPRINGS, FL, 32714 |
| Name | Role | Address |
|---|---|---|
| DELAUZ-SAMI LUCIA | Vice President | 207 NW LAKE VALLEY TER, LAKE CITY, FL, 32055 |
| Name | Role | Address |
|---|---|---|
| DELAUZ-SAMI LUCIA | Treasurer | 207 NW LAKE VALLEY TER, LAKE CITY, FL, 32055 |
| Name | Role | Address |
|---|---|---|
| DELAUZ-SAMI LUCIA | Secretary | 207 NW LAKE VALLEY TER, LAKE CITY, FL, 32055 |
| Name | Role | Address |
|---|---|---|
| DELAUZ-SAMI LUCIA | Director | 207 NW LAKE VALLEY TER, LAKE CITY, FL, 32055 |
| Name | Role | Address |
|---|---|---|
| DELAUZ-SAMI LUCIA | Commissioner | 207 NW LAKE VALLEY TER, LAKE CITY, FL, 32055 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2010-09-24 | No data | No data |
| AMENDMENT | 2009-11-02 | No data | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J11000437710 | LAPSED | 1000000221789 | COLUMBIA | 2011-06-24 | 2021-07-20 | $ 670.80 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, MAITLAND SERVICE CENTER, 2301 MAITLAND CENTER PKWY STE 160, MAITLAND FL327514192 |
Date of last update: 02 Jan 2025
Sources: Florida Department of State
