| Entity Name: | STAT MEDICAL CLINIC, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 06 Jun 1980 (45 years ago) |
| Document Number: | 672662 |
| FEI/EIN Number | 592006392 |
| Address: | 9526 NE 2 AVENUE, MIAMI SHORES, FL, 33138 |
| Mail Address: | 9526 NE 2 AVENUE, MIAMI SHORES, FL, 33138 |
| ZIP code: | 33138 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1245456169 | 2007-04-18 | 2008-09-04 | 9526 NE 2ND AVE, SUITE 202, MIAMI SHORES, FL, 331382750, US | 9526 NE 2ND AVE, SUITE 202, MIAMI SHORES, FL, 331382750, US | |||||||||||||||||||||||
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| Phone | +1 305-756-9466 |
Authorized person
| Name | RAMON BERENGUER |
| Role | MD |
| Phone | 3057569466 |
Taxonomy
| Taxonomy Code | 208D00000X - General Practice Physician |
| License Number | ME88240 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 207707100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| PAUL SALVER, PA | Agent | 2721 EXECUTIVE PARK DRIVE, WESTON, FL, 33331 |
| Name | Role | Address |
|---|---|---|
| BERENGUER RAMON | President | 9526 NE 2 AVENUE, MIAMI SHORES, FL, 33138 |
| Name | Role | Address |
|---|---|---|
| GREEN STEFANI | Vice President | 9526 NE 2 AVENUE, MIAMI SHORES, FL, 33138 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2009-09-25 | No data | No data |
| CANCEL ADM DISS/REV | 2007-11-21 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2007-09-14 | No data | No data |
| CANCEL ADM DISS/REV | 2006-10-05 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2006-09-15 | No data | No data |
| AMENDMENT | 2005-11-08 | No data | No data |
| NAME CHANGE AMENDMENT | 1991-08-29 | STAT MEDICAL CLINIC, INC. | No data |
Date of last update: 01 Jan 2025
Sources: Florida Department of State
