| Entity Name: | OMNICARE MEDICAL CENTER, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 22 Jan 1999 (26 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 14 Apr 2023 (2 years ago) |
| Document Number: | P99000006482 |
| FEI/EIN Number | 593616020 |
| Address: | 1805 W.COLONIAL DR., SUITE A, ORLANDO, FL, 32804 |
| Mail Address: | 1805 W.COLONIAL DR., SUITE A, ORLANDO, FL, 32804 |
| ZIP code: | 32804 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1073874145 | 2012-06-05 | 2012-10-24 | 1805 W COLONIAL DR, SUITE A, ORLANDO, FL, 328047013, US | 1805 W COLONIAL DR, SUITE A, ORLANDO, FL, 328047013, US | |||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||
| Phone | +1 407-578-9142 |
| Fax | 4075788616 |
Authorized person
| Name | OWEN D FRASER |
| Role | PHYSICIAN/OWNER |
| Phone | 4075789142 |
Taxonomy
| Taxonomy Code | 261QM2500X - Medical Specialty Clinic/Center |
| License Number | ME30256 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 58757500 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| FRASER OWEN D | Agent | 1805 W. COLONIAL DR., ORLANDO, FL, 32804 |
| Name | Role | Address |
|---|---|---|
| FRASER OWEN D | President | 1805 W. COLONIAL DR. STE. A, ORLANDO, FL, 32804 |
| Name | Role | Address |
|---|---|---|
| FRASER OWEN D | Treasurer | 1805 W. COLONIAL DR. STE. A, ORLANDO, FL, 32804 |
| Name | Role | Address |
|---|---|---|
| FRASER OWEN D | Director | 1805 W. COLONIAL DR. STE. A, ORLANDO, FL, 32804 |
| GLEN ELYSE | Director | 1805 W.COLONIAL DR., ORLANDO, FL, 32804 |
| Name | Role | Address |
|---|---|---|
| GLEN ELYSE | Vice President | 1805 W.COLONIAL DR., ORLANDO, FL, 32804 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2023-04-14 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2019-09-27 | No data | No data |
| REINSTATEMENT | 2016-01-04 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2016-01-04 | FRASER, OWEN D | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2015-09-25 | No data | No data |
| PENDING REINSTATEMENT | 2011-10-19 | No data | No data |
| REINSTATEMENT | 2011-10-18 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2011-10-18 | 1805 W.COLONIAL DR., SUITE A, ORLANDO, FL 32804 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2011-10-18 | 1805 W.COLONIAL DR., SUITE A, ORLANDO, FL 32804 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2011-10-18 | 1805 W. COLONIAL DR., SUITE A, ORLANDO, FL 32804 | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J24000189652 | ACTIVE | 1000000984917 | ORANGE | 2024-03-20 | 2034-04-03 | $ 1,345.41 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, ORLANDO SERVICE CENTER, 400 W ROBINSON ST STE N302, ORLANDO FL328011759 |
| J22000102626 | ACTIVE | 1000000914389 | ORANGE | 2022-02-02 | 2032-03-02 | $ 610.40 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, ORLANDO SERVICE CENTER, 400 W ROBINSON ST STE N302, ORLANDO FL328011759 |
| J13000453507 | TERMINATED | 1000000428088 | ORANGE | 2013-01-30 | 2023-02-20 | $ 1,150.97 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, MAITLAND SERVICE CENTER, 2301 MAITLAND CENTER PKWY STE 160, MAITLAND FL327514192 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-14 |
| REINSTATEMENT | 2023-04-14 |
| ANNUAL REPORT | 2018-04-30 |
| ANNUAL REPORT | 2017-05-01 |
| REINSTATEMENT | 2016-01-04 |
| ANNUAL REPORT | 2014-04-22 |
| ANNUAL REPORT | 2013-09-12 |
| ANNUAL REPORT | 2012-06-08 |
| REINSTATEMENT | 2011-10-18 |
| REINSTATEMENT | 2009-10-15 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
