| Entity Name: | ST. JOHN CLINIC MEDICAL CENTER, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 08 Sep 1982 (42 years ago) |
| Document Number: | F98691 |
| FEI/EIN Number | 59-2226330 |
| Address: | 156 NW 29th Street, MIAMI, FL 33127 |
| Mail Address: | 156 NW 29th Street, MIAMI, FL 33127 |
| ZIP code: | 33127 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1760470652 | 2005-10-13 | 2022-07-21 | 161 NW 29TH ST, MIAMI, FL, 331273929, US | 161 NW 29TH ST, MIAMI, FL, 331273929, US | |||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 305-576-0231 |
| Fax | 3055731458 |
Authorized person
| Name | MR. REYNALDO CRUZ |
| Role | CEO |
| Phone | 3055760231 |
Taxonomy
| Taxonomy Code | 261Q00000X - Clinic/Center |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 261QM1300X - Multi-Specialty Clinic/Center |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | TOTAL HEALTH CHOICE |
| Number | 4624 |
| State | FL |
| Issuer | MEDICAID |
| Number | 060387200 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CRUZ, REINALDO | Agent | 156 NW 29th Street, MIAMI, FL 33127 |
| Name | Role | Address |
|---|---|---|
| CRUZ, REINALDO | President | 156 NW 29th Street, MIAMI, FL 33127 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2021-10-09 | 156 NW 29th Street, MIAMI, FL 33127 | No data |
| CHANGE OF MAILING ADDRESS | 2021-10-09 | 156 NW 29th Street, MIAMI, FL 33127 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-10-09 | 156 NW 29th Street, MIAMI, FL 33127 | No data |
| REGISTERED AGENT NAME CHANGED | 2005-02-11 | CRUZ, REINALDO | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-16 |
| ANNUAL REPORT | 2024-02-02 |
| ANNUAL REPORT | 2023-01-23 |
| ANNUAL REPORT | 2022-01-24 |
| AMENDED ANNUAL REPORT | 2021-10-09 |
| ANNUAL REPORT | 2021-01-11 |
| ANNUAL REPORT | 2020-01-15 |
| ANNUAL REPORT | 2019-01-28 |
| ANNUAL REPORT | 2018-01-12 |
| ANNUAL REPORT | 2017-01-06 |
Date of last update: 05 Feb 2025
Sources: Florida Department of State
