| Entity Name: | PALM BEACH REGIONAL MRI, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 29 Jul 1999 (26 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 16 Feb 2018 (7 years ago) |
| Document Number: | P99000067723 |
| FEI/EIN Number | 650937561 |
| Address: | 701 NORTHLAKE BLVD, SUITE 106, NORTH PALM BEACH, FL, 33408, US |
| Mail Address: | 173 MAIN STREET, THOMASTON, ME, 04861, US |
| ZIP code: | 33408 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1245236678 | 2005-06-21 | 2018-11-22 | 173 MAIN ST, THOMASTON, ME, 048613807, US | 701 NORTHLAKE BLVD, STE 106, NORTH PALM BEACH, FL, 334085215, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 561-882-0674 |
| Fax | 5618824141 |
Authorized person
| Name | MR. MARTIN J FARRELL |
| Role | OWNER/CEO |
| Phone | 2077066810 |
Taxonomy
| Taxonomy Code | 261QM1200X - Magnetic Resonance Imaging (MRI) Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | NEIGHBORHOOD HEALTH ID # |
| Number | 40820 |
| State | FL |
| Issuer | MEDICAID |
| Number | 510017800 |
| State | FL |
| Issuer | BCBS ID NUMBER |
| Number | 72435 |
| State | FL |
| Name | Role |
|---|---|
| INCORP SERVICES, INC. | Agent |
| Name | Role | Address |
|---|---|---|
| FARRELL MARTIN J | Secretary | 173 MAIN STREET, THOMASTON, ME, 04861 |
| Name | Role | Address |
|---|---|---|
| FARRELL MARTIN J | Director | 173 MAIN STREET, THOMASTON, ME, 04861 |
| Name | Role | Address |
|---|---|---|
| FARRELL MARTIN J | President | 173 MAIN STREET, THOMASTON, ME, 04861 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G19000133128 | CMI NORTH | ACTIVE | 2019-12-17 | 2029-12-31 | No data | 173 MAIN STREET, THOMASTON, ME, 04861 |
| G19000124467 | CMI PALM BEACH | EXPIRED | 2019-11-21 | 2024-12-31 | No data | PO BOX 1169, ROCKLAND, ME, 04841 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2023-03-29 | InCorp Services, Inc. | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-03-29 | 3458 Lakeshore Drive, Tallahassee, FL 32312 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2019-02-20 | 701 NORTHLAKE BLVD, SUITE 106, NORTH PALM BEACH, FL 33408 | No data |
| CHANGE OF MAILING ADDRESS | 2018-02-24 | 701 NORTHLAKE BLVD, SUITE 106, NORTH PALM BEACH, FL 33408 | No data |
| AMENDMENT | 2018-02-16 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-05 |
| ANNUAL REPORT | 2023-03-29 |
| Reg. Agent Resignation | 2022-05-09 |
| ANNUAL REPORT | 2022-01-24 |
| ANNUAL REPORT | 2021-02-04 |
| ANNUAL REPORT | 2020-03-12 |
| ANNUAL REPORT | 2019-02-20 |
| ANNUAL REPORT | 2018-02-24 |
| Amendment | 2018-02-16 |
| ANNUAL REPORT | 2017-01-27 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
