| Entity Name: | JRJ PODIATRY, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 14 Oct 1998 (26 years ago) |
| Document Number: | P98000087795 |
| FEI/EIN Number | 650869599 |
| Address: | 4000 STATE RD 7, SUITE 412, FORT LAUDERDALE, FL, 33319, US |
| Mail Address: | 4000 STATE RD 7, SUITE 412, FORT LAUDERDALE, FL, 33319, US |
| ZIP code: | 33319 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1083610638 | 2005-06-27 | 2008-12-29 | 4000 N STATE ROAD 7, STE 412, LAUDERDALE LAKES, FL, 333194882, US | 4000 N STATE ROAD 7, STE 412, LAUDERDALE LAKES, FL, 333194882, US | |||||||||||||||||||||||||
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| Phone | +1 954-731-0028 |
| Fax | 9547310288 |
Authorized person
| Name | DR. JEANETTE R JOHNSON |
| Role | OWNER/PRESIDENT |
| Phone | 9547310028 |
Taxonomy
| Taxonomy Code | 213E00000X - Podiatrist |
| License Number | PO2654 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 390400801 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| JOHNSON JEANETTE | Agent | 1227 SEAVIEW, NORTH LAUDERDALE, FL, 33068 |
| Name | Role | Address |
|---|---|---|
| JOHNSON JEANETTE R | Director | 1227 SEAVIEW, NORTH LAUDERDALE, FL, 33068 |
| Name | Role | Address |
|---|---|---|
| JOHNSON JEANETTE R | President | 1227 SEAVIEW, NORTH LAUDERDALE, FL, 33068 |
| Name | Role | Address |
|---|---|---|
| JOHNSON A. W. | Vice President | 1227 SEAVIEW, NORTH LAUDERDALE, FL, 33068 |
| Name | Role | Address |
|---|---|---|
| JOHNSON A. W. | Manager | 1227 SEAVIEW, NORTH LAUDERDALE, FL, 33068 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2008-09-22 | No data | No data |
Date of last update: 02 Jan 2025
Sources: Florida Department of State
