| Entity Name: | INTEGRATED MEDICAL GROUP, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 12 Oct 1998 (26 years ago) |
| Date of dissolution: | 22 Oct 2015 (9 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 22 Oct 2015 (9 years ago) |
| Document Number: | P98000087346 |
| FEI/EIN Number | 593540826 |
| Address: | 3626 HEDRICK ST., JACKSONVILLE, FL, 32205, US |
| Mail Address: | 3626 HEDRICK ST., JACKSONVILLE, FL, 32205, US |
| ZIP code: | 32205 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1578782132 | 2007-04-24 | 2010-09-08 | 2401 GRAND BLVD, HOLIDAY, FL, 346904508, US | 2401 GRAND BLVD, HOLIDAY, FL, 346904508, US | |||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 727-934-5757 |
| Fax | 7279376258 |
Authorized person
| Name | DAVID HUBER |
| Role | PROVIDER OWNER |
| Phone | 7279345757 |
Taxonomy
| Taxonomy Code | 111N00000X - Chiropractor |
| License Number | CH2603 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | AMERIGROUP GROUP ID |
| Number | 235001 |
| State | FL |
| Issuer | BLUE CROSS GROUP PROVIDER |
| Number | 55738 |
| State | FL |
| Issuer | MEDICAID |
| Number | 381250200 |
| State | FL |
| Issuer | AVMED GROUP ID |
| Number | 280679 |
| State | FL |
| Issuer | STAYWELL GROUP ID |
| Number | 176018 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| HUBER DAVID C | Agent | 3626 HEDRICK ST., JACKSONVILLE, FL, 32205 |
| Name | Role | Address |
|---|---|---|
| HUBER DAVID C | Director | 3626 HEDRICK ST., JACKSONVILLE, FL, 32205 |
| Name | Role | Address |
|---|---|---|
| HUBER DAVID C | President | 3626 HEDRICK ST., JACKSONVILLE, FL, 32205 |
| Name | Role | Address |
|---|---|---|
| HUBER DAVID C | Vice President | 3626 HEDRICK ST., JACKSONVILLE, FL, 32205 |
| Name | Role | Address |
|---|---|---|
| HUBER DAVID C | Secretary | 3626 HEDRICK ST., JACKSONVILLE, FL, 32205 |
| Name | Role | Address |
|---|---|---|
| HUBER DAVID C | Treasurer | HEDRICK ST., JACKSONVILLE, FL, 32205 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2015-10-22 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2012-01-10 | 3626 HEDRICK ST., JACKSONVILLE, FL 32205 | No data |
| CHANGE OF MAILING ADDRESS | 2012-01-10 | 3626 HEDRICK ST., JACKSONVILLE, FL 32205 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2012-01-10 | 3626 HEDRICK ST., JACKSONVILLE, FL 32205 | No data |
| Name | Date |
|---|---|
| Voluntary Dissolution | 2015-10-22 |
| ANNUAL REPORT | 2015-01-15 |
| ANNUAL REPORT | 2014-01-15 |
| ANNUAL REPORT | 2013-01-16 |
| ANNUAL REPORT | 2012-01-10 |
| ANNUAL REPORT | 2011-01-07 |
| ANNUAL REPORT | 2010-02-22 |
| ANNUAL REPORT | 2009-03-28 |
| ANNUAL REPORT | 2008-01-16 |
| ANNUAL REPORT | 2007-02-16 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
