| Entity Name: | HAWTHORNE MEDICAL CENTER, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 07 Oct 1998 (26 years ago) |
| Date of dissolution: | 13 Jun 2011 (14 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 13 Jun 2011 (14 years ago) |
| Document Number: | P98000086472 |
| FEI/EIN Number | 593537283 |
| Address: | 21815 SOUTHEAST 71ST AVENUE, HAWTHORNE, FL, 32640, US |
| Mail Address: | 2090 CARPENTER PIKE, VERSAILLES, KY, 40383, US |
| ZIP code: | 32640 |
| County: | Putnam |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1023196318 | 2006-11-02 | 2009-07-06 | 21815 S.E .71ST AVENUE, HAWTHORNE, FL, 326403974, US | 21815 S.E .71ST AVENUE, HAWTHORNE, FL, 326403974, US | |||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 352-481-2400 |
| Fax | 3524812777 |
Authorized person
| Name | PATRICIA O MCCULLOUGH |
| Role | PRESIDENT/OWNER |
| Phone | 3524812400 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | ME63062 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | HCC8421 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 37209S100 |
| State | FL |
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | 45696 |
| State | FL |
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | 18622 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MCCULLOUGH PATRICIA | Agent | 21815 SOUTHEAST 71ST AVE., HAWTHORNE, FL, 32640 |
| Name | Role | Address |
|---|---|---|
| MCCULLOUGH PATRICIA | President | 21815 SOUTHEAST 71ST AVE, HAWTHORNE, FL, 32640 |
| Name | Role | Address |
|---|---|---|
| HENSBY PATRICIA | Secretary | 3534 SPLIT RAIL LANE, ELLICOTT CITY, MD, 21042 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G08182900237 | HAWTHORNE MEDICAL CENTER | EXPIRED | 2008-06-30 | 2013-12-31 | No data | 21815 SOUTHEAST 71ST AVENUE, HAWTHORNE, FL, 32640 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2011-06-13 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2009-04-01 | 21815 SOUTHEAST 71ST AVENUE, HAWTHORNE, FL 32640 | No data |
| AMENDED AND RESTATEDARTICLES/NAME CHANGE | 2009-03-11 | HAWTHORNE MEDICAL CENTER, INC. | No data |
| REGISTERED AGENT NAME CHANGED | 2009-03-11 | MCCULLOUGH, PATRICIA | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2009-03-11 | 21815 SOUTHEAST 71ST AVE., HAWTHORNE, FL 32640 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2001-05-10 | 21815 SOUTHEAST 71ST AVENUE, HAWTHORNE, FL 32640 | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J11000023056 | LAPSED | 2010 CC 004817 NC | 12TH JUDICIAL, SARASOTA CO. | 2011-01-07 | 2016-01-14 | $10,422.13 | KERKERING, BARBERIO & CO., 1990 MAIN STREET, SUITE 801, SARASOTA, FL 34236 |
| Name | Date |
|---|---|
| Voluntary Dissolution | 2011-06-13 |
| ANNUAL REPORT | 2010-02-19 |
| ANNUAL REPORT | 2009-04-01 |
| Amended/Restated Article/NC | 2009-03-11 |
| ANNUAL REPORT | 2008-04-03 |
| ANNUAL REPORT | 2007-07-03 |
| ANNUAL REPORT | 2006-07-11 |
| ANNUAL REPORT | 2005-01-17 |
| ANNUAL REPORT | 2004-07-06 |
| ANNUAL REPORT | 2003-02-19 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
