| Entity Name: | PEMBROKE PINES MEDICAL CENTER, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 30 Aug 1977 (47 years ago) |
| Document Number: | 544121 |
| FEI/EIN Number | 000000000 |
| Address: | 2131 HOLLYWOOD BLVD, SUITE 205, HOLLYWOOD, FL, 33020 |
| Mail Address: | 2131 HOLLYWOOD BLVD, SUITE 205, HOLLYWOOD, FL, 33020 |
| ZIP code: | 33020 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 1588849723 | 2008-01-07 | 2010-03-10 | 18219 PINES BLVD, PEMBROKE PINES, FL, 330291417, US | 18219 PINES BLVD, PEMBROKE PINES, FL, 330291417, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 954-436-1212 |
| Fax | 9544355444 |
Authorized person
| Name | RICHARD A KOBY |
| Role | VICE PRESIDENT |
| Phone | 3058216600 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | ME49055 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | AVMED KOBY |
| Number | 014686 |
| State | FL |
| Issuer | AETNA KOBY |
| Number | 4337911 |
| State | FL |
| Issuer | AVMED ZALIS |
| Number | 265997 |
| State | FL |
| Issuer | BCBS ZALIS |
| Number | 79162 |
| State | FL |
| Issuer | HUMANA |
| Number | 170130 |
| State | FL |
| Issuer | MCR KOBY |
| Number | 02704 |
| State | FL |
| Issuer | MEDICAID |
| Number | 044892300 |
| State | FL |
| Issuer | NHP ZALIS |
| Number | 001729 |
| State | FL |
| Issuer | NHP KOBY |
| Number | 000901 |
| State | FL |
| Issuer | MEDICAID |
| Number | 039823300 |
| State | FL |
| Issuer | AETNA ZALIS |
| Number | 4521008 |
| State | FL |
| Issuer | JMH KOBY |
| Number | 7900000 |
| State | FL |
| Issuer | MCR ZALIS |
| Number | 79162 |
| State | FL |
| Issuer | BCBS KOBY |
| Number | 02704 |
| State | FL |
| Issuer | JMH ZALIS |
| Number | 6972300 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SIMRING, ELLIS S. | Agent | 2131 HOLLYWOOD BLVD, HOLLYWOOD, FL, 33020 |
| Name | Role | Address |
|---|---|---|
| SIMRING, ELLIS | President | 2131 HOLLYWOOD BLVD #205, HOLLYWOOD, FL |
| Name | Role | Address |
|---|---|---|
| SIMRING, ELLIS | Director | 2131 HOLLYWOOD BLVD #205, HOLLYWOOD, FL |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| INVOLUNTARILY DISSOLVED | 1978-12-05 | No data | No data |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
