| Entity Name: | TRI-COUNTY PULMONARY & MULTI-SPECIALTY GROUP, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 04 Mar 1999 (26 years ago) |
| Date of dissolution: | 26 Sep 2014 (10 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 26 Sep 2014 (10 years ago) |
| Document Number: | P99000020513 |
| FEI/EIN Number | 593561297 |
| Address: | 1507 BUENOS AIRES BLVD., THE VILLAGES, FL, 32159 |
| Mail Address: | 1507 BUENOS AIRES BLVD., THE VILLAGES, FL, 32159 |
| ZIP code: | 32159 |
| County: | Lake |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1003890294 | 2005-12-01 | 2008-06-18 | 1507 BUENOS AIRES BLVD, THE VILLAGES, FL, 321598974, US | 1507 BUENOS AIRES BLVD, THE VILLAGES, FL, 321598974, US | |||||||||||||||||||||
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| Phone | +1 352-350-1600 |
| Fax | 3527508032 |
Authorized person
| Name | MR. DAN ARSENIJEVITH |
| Role | BUSINESS ADMINISTRATOR |
| Phone | 3523501556 |
Taxonomy
| Taxonomy Code | 207RP1001X - Pulmonary Disease Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 262056100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| KRAUCAK NELSON | Agent | 1507 BUENOS AIRES BLVD., THE VILLAGES, FL, 32159 |
| Name | Role | Address |
|---|---|---|
| VILLA MARIVIC M | President | 11201 SE SUNSET HARBOR RD., SUMMERFIELD, FL, 34491 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G11000034527 | VMG PULMONARY & SLEEP DISORDER CENTER, PA | EXPIRED | 2011-04-07 | 2016-12-31 | No data | 3365 WEDGEWOOD LANE, THE VILLAGES, FL, 32162 |
| G08311900108 | VILLA MEDICAL GROUP | EXPIRED | 2008-11-06 | 2013-12-31 | No data | 1507 BUENOS AIRES BOULEVARD, THE VILLAGES, FL, 32159 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2014-09-26 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2011-04-04 | KRAUCAK, NELSON | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2007-02-22 | 1507 BUENOS AIRES BLVD., THE VILLAGES, FL 32159 | No data |
| CHANGE OF MAILING ADDRESS | 2007-02-22 | 1507 BUENOS AIRES BLVD., THE VILLAGES, FL 32159 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2013-04-29 |
| ANNUAL REPORT | 2012-02-07 |
| ANNUAL REPORT | 2011-04-20 |
| Reg. Agent Change | 2011-04-04 |
| ANNUAL REPORT | 2010-03-29 |
| ANNUAL REPORT | 2009-05-01 |
| ANNUAL REPORT | 2008-04-15 |
| ANNUAL REPORT | 2007-02-22 |
| ANNUAL REPORT | 2006-01-13 |
| ANNUAL REPORT | 2005-01-20 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
