| Entity Name: | THE DIGESTIVE AND LIVER CENTER OF MELBOURNE, L.L.C. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 04 Jun 2001 (24 years ago) |
| Document Number: | L01000008819 |
| FEI/EIN Number | 593726212 |
| Address: | 25 E. SILVER PALM AVE., MELBOURNE, FL, 32901 |
| Mail Address: | P.O. BOX 1988, MELBOURNE, FL, 32902 |
| ZIP code: | 32901 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1659446425 | 2006-11-21 | 2012-03-22 | 25 SILVER PALM AVE, SUITE B, MELBOURNE, FL, 329013177, US | 25 E SILVER PALM AVE, SUITE B, MELBOURNE, FL, 329013177, US | |||||||||||||||||||||||||
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| Phone | +1 321-725-4150 |
| Fax | 3217331335 |
Authorized person
| Name | MR. MAGED DOSS FARID |
| Role | OWNER |
| Phone | 3217525210 |
Taxonomy
| Taxonomy Code | 261QE0800X - Endoscopy Clinic/Center |
| License Number | 1165 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 075356400 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MAGED FARID | Agent | 250 S WICKHAM RD, MELBOURNE, FL, 32904 |
| Name | Role | Address |
|---|---|---|
| GADALLAH SHIREEN F | Managing Member | 25 SILVER PALM AVE SUITE B, MELBOURNE, FL, 32901 |
| FARID MAGED | Managing Member | 25 SILVER PALM AVE SUITE B, MELBOURNE, FL, 32901 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2013-04-29 | 250 S WICKHAM RD, MELBOURNE, FL 32904 | No data |
| REGISTERED AGENT NAME CHANGED | 2003-08-10 | MAGED, FARID | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-05-01 |
| ANNUAL REPORT | 2023-04-30 |
| ANNUAL REPORT | 2022-04-30 |
| ANNUAL REPORT | 2021-04-30 |
| ANNUAL REPORT | 2020-06-28 |
| ANNUAL REPORT | 2019-04-30 |
| ANNUAL REPORT | 2018-04-30 |
| ANNUAL REPORT | 2017-05-01 |
| ANNUAL REPORT | 2016-04-30 |
| ANNUAL REPORT | 2015-04-30 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
