| Entity Name: | INSTITUTE OF INTERNAL MEDICINE, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Domestic Profit
INSTITUTE OF INTERNAL MEDICINE, P.A. is structured as a Domestic Profit Corporation, which, in Florida signifies a Profit Corporation (also known as a C-Corporation). This business structure is recognized as a separate legal entity from its owners. This offers shareholders the benefit of limited liability protection, safeguarding their personal assets from the corporation's debts and obligations, and facilitates raising capital through the issuance of stock. In Florida, Domestic Profit Corporations are governed by Title XXXVI, Chapter 607, Florida Statutes – Florida Business Corporation Act. |
| Status: |
Inactive
The business entity is inactive. This status may signal operational issues or voluntary closure, raising concerns about the business's ability to repay loans and requiring careful risk assessment by lenders. |
| Date Filed: | 09 Aug 1999 (26 years ago) |
| Date of dissolution: | 27 Sep 2019 (6 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 27 Sep 2019 (6 years ago) |
| Document Number: | P99000072610 |
| FEI/EIN Number |
593638351
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 1301 PLANTATION ISLAND DRIVE, SUITE402B, SAINT AUGUSTINE, FL, 32080 |
| Mail Address: | 1301 PLANTATION ISLAND DRIVE, SUITE402B, SAINT AUGUSTINE, FL, 32080 |
| ZIP code: | 32080 |
| County: | St. Johns |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1457523003 | 2008-03-24 | 2011-09-15 | 1301 PLANTATION ISLAND DR S, STE 402-B, ST AUGUSTINE, FL, 320803108, US | 1301 PLANTATION ISLAND DR S, STE 402B, ST AUGUSTINE, FL, 320803108, US | |||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 904-460-0707 |
Authorized person
| Name | CARMEN C VIVERO |
| Role | PRESIDENT |
| Phone | 9044600707 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | ME76599 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 207RA0401X - Addiction Medicine (Internal Medicine) Physician |
| License Number | ME76599 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | RR MEDICARE |
| Number | DN9360 |
| State | FL |
| Issuer | BCBS |
| Number | 44784 |
| State | FL |
| Issuer | MEDICAID |
| Number | 003271700 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| VIVERO CARMEN | President | 1301 PLANTATION ISLAND DRIVE, SAINT AUGUSTINE, FL, 32080 |
| VIVERO CARMEN | Agent | 1301 PLANTATION ISLAND DRIVE, SAINT AUGUSTINE, FL, 32084 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2019-09-27 | - | - |
| CHANGE OF PRINCIPAL ADDRESS | 2012-04-11 | 1301 PLANTATION ISLAND DRIVE, SUITE402B, SAINT AUGUSTINE, FL 32080 | - |
| REGISTERED AGENT ADDRESS CHANGED | 2012-04-11 | 1301 PLANTATION ISLAND DRIVE, SAINT AUGUSTINE, FL 32084 | - |
| REINSTATEMENT | 2012-04-11 | - | - |
| CHANGE OF MAILING ADDRESS | 2012-04-11 | 1301 PLANTATION ISLAND DRIVE, SUITE402B, SAINT AUGUSTINE, FL 32080 | - |
| REGISTERED AGENT NAME CHANGED | 2012-04-11 | VIVERO, CARMEN | - |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2006-09-15 | - | - |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J22000266082 | ACTIVE | 1000000924513 | ST JOHNS | 2022-05-26 | 2032-06-01 | $ 881.38 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, JACKSONVILLE SERVICE CENTER, 921 N DAVIS ST STE 250A, JACKSONVILLE FL322096825 |
| J21000264006 | ACTIVE | 1000000890323 | ST JOHNS | 2021-05-24 | 2031-05-26 | $ 1,192.31 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, JACKSONVILLE SERVICE CENTER, 921 N DAVIS ST STE 250A, JACKSONVILLE FL322096825 |
| J19000733723 | ACTIVE | 1000000846814 | ST JOHNS | 2019-10-30 | 2029-11-06 | $ 707.29 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, JACKSONVILLE SERVICE CENTER, 921 N DAVIS ST STE 250A, JACKSONVILLE FL322096825 |
| J19000192961 | ACTIVE | 1000000818384 | ST JOHNS | 2019-03-05 | 2029-03-13 | $ 413.03 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, JACKSONVILLE SERVICE CENTER, 921 N DAVIS ST STE 250A, JACKSONVILLE FL322096825 |
| J18000150490 | TERMINATED | 1000000778976 | ST JOHNS | 2018-04-09 | 2028-04-11 | $ 645.15 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, JACKSONVILLE SERVICE CENTER, 921 N DAVIS ST STE 250A, JACKSONVILLE FL322096825 |
| J17000582611 | TERMINATED | 1000000758562 | ST JOHNS | 2017-10-09 | 2027-10-20 | $ 1,020.74 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, JACKSONVILLE SERVICE CENTER, 921 N DAVIS ST STE 250A, JACKSONVILLE FL322096825 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2018-04-07 |
| ANNUAL REPORT | 2017-04-26 |
| ANNUAL REPORT | 2016-04-25 |
| ANNUAL REPORT | 2015-03-18 |
| ANNUAL REPORT | 2014-03-28 |
| ANNUAL REPORT | 2013-04-25 |
| REINSTATEMENT | 2012-04-11 |
| ANNUAL REPORT | 2005-04-22 |
| ANNUAL REPORT | 2004-04-30 |
| ANNUAL REPORT | 2003-01-23 |
Date of last update: 01 Apr 2025
Sources: Florida Department of State
