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Blackwater Medical LLC

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Company Details

Name: Blackwater Medical LLC
Jurisdiction: MISSISSIPPI
Business Type: Limited Liability Company
Status: Dissolved
Effective Date: 06 Dec 2005 (20 years ago)
Branch of: Blackwater Medical LLC, FLORIDA (Company Number L10000030264)
Business ID: 882543
State of Incorporation: FLORIDA
Principal Office Address: 18 Racetrack Rd NWFort Walton Beach, FL 32547

Agent

Name Role Address
Brewer, David L Agent 751 Avignon Drive Ste F, Ridgeland, MS 39158

Manager

Name Role Address
Jim Collins Manager 1029 Highway 51 Suite F2 #36, Madison, MS 39110

National Provider Identifier

NPI Number:
1033343603

Authorized Person:

Name:
MR. JAMES F COLLINS
Role:
PRESIDENT
Phone:

Taxonomy:

Selected Taxonomy:
332B00000X - Durable Medical Equipment & Medical Supplies
Is Primary:
Yes

Contacts:

Fax:
8666913186

Filings

Type Status Filed Date Description
Failure to File AR Filed 2011-12-05 Failure to File AR
Formation Form Filed 2005-12-06 Formation

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Date of last update: 05 May 2025

Sources: Company Profile on Mississippi Secretary of State Website