REVAN LLC
Osteopathic Medicine at Tampa Rd, Palm Harbor, FL

License number
Florida OS4598
Category
Osteopathic Medicine
Type
Undersea and Hyperbaric Medicine
Owner
Name: CHARLES BOOTHBY D.O.
Title: OWNER
Phone: (727) 869-5551
Address
Address 2
3890 Tampa Rd STE 201, Palm Harbor, FL 34684
PO Box 25513, Tampa, FL 33622
National Provider ID: 1730145673
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

See more information about REVAN LLC at bizstanding.com

REVAN, LLC

Palm Harbor, FL  -  Dunedin, FL

Status:
Inactive
Inactive reason:
REINSTATEMENT
Registration:
Sep 12, 2005
Inactive since:
Oct 18, 2006
Addresses:
3890 Tampa Rd SUITE 201, Palm Harbor, FL 34684 (Physical)
Dunedin, FL 34697 (Mailing)
PO Box 2278, Dunedin, FL 34697
State ID:
L05000089245
Business type:
Florida Limited Liability Company
Managing Member:
Charles M Boothby (Managing Member), 3890 Tampa Rd STE 201, Palm Harbor, FL 34684 (Physical)
Agent:
Charles Boothby,3890 Tampa Rd/ SUITE 201, Palm Harbor, FL 34684 (Physical)
EIN:
203193036

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