| Entity Name: | MILLENNIUM DIAGNOSTIC IMAGING CENTER, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 23 Nov 1998 (26 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 29 Sep 2023 (a year ago) |
| Document Number: | P98000098445 |
| FEI/EIN Number | 650905210 |
| Address: | 8900 CORAL WAY, 100, MIAMI, FL, 33165, US |
| Mail Address: | 8900 CORAL WAY, 100, MIAMI, FL, 33165, US |
| ZIP code: | 33165 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1952314940 | 2006-08-14 | 2021-07-13 | 8900 SW 24TH ST, SUITE 100, MIAMI, FL, 331652075, US | 8900 SW 24TH ST, SUITE 100, MIAMI, FL, 331652075, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 305-229-9511 |
| Fax | 3052299112 |
Authorized person
| Name | MR. JOSE LORENZO GALARZA |
| Role | PRESIDENT |
| Phone | 3052299511 |
Taxonomy
| Taxonomy Code | 261QM1200X - Magnetic Resonance Imaging (MRI) Clinic/Center |
| License Number | HCC4575 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | AMERIGROUP |
| Number | 272346 |
| State | FL |
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | V2847 |
| State | FL |
| Issuer | FLORIDA NET PASS |
| Number | 261893100 |
| State | FL |
| Issuer | WELLCARE |
| Number | 246371 |
| State | FL |
| Issuer | MEDICAID |
| Number | 261893100 |
| State | FL |
| Issuer | AVMED |
| Number | 292178 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| DIAZ IVETTE | Agent | 8900 CORAL WAY, MIAMI, FL, 33165 |
| Name | Role | Address |
|---|---|---|
| DIAZ IVETTE | President | 8900 CORAL WAY, MIAMI, FL, 33165 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2023-09-29 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2023-09-22 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2022-08-08 | DIAZ, IVETTE | No data |
| CHANGE OF MAILING ADDRESS | 2022-02-03 | 8900 CORAL WAY, 100, MIAMI, FL 33165 | No data |
| AMENDMENT | 2021-07-16 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2012-04-11 | 8900 CORAL WAY, 100, MIAMI, FL 33165 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2010-05-26 | 8900 CORAL WAY, 100, MIAMI, FL 33165 | No data |
| REINSTATEMENT | 2000-10-23 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2000-09-22 | No data | No data |
| Name | Date |
|---|---|
| AMENDED ANNUAL REPORT | 2024-09-04 |
| AMENDED ANNUAL REPORT | 2024-06-21 |
| ANNUAL REPORT | 2024-04-16 |
| REINSTATEMENT | 2023-09-29 |
| AMENDED ANNUAL REPORT | 2022-08-08 |
| ANNUAL REPORT | 2022-02-03 |
| Amendment | 2021-07-16 |
| ANNUAL REPORT | 2021-04-29 |
| ANNUAL REPORT | 2020-05-22 |
| ANNUAL REPORT | 2019-04-27 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
