| Entity Name: | PULMONOLOGY AND SLEEP CENTER LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 17 Dec 2001 (23 years ago) |
| Document Number: | L01000021790 |
| FEI/EIN Number | 651157149 |
| Address: | 2300 SOUTH CONGRESS AVENUE, SUITE 101, BOYNTON BEACH, FL, 33426 |
| Mail Address: | PO BOX 550, BOYNTON BEACH, FL, 33435 |
| ZIP code: | 33426 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1447266085 | 2006-08-01 | 2012-10-29 | PO BOX 550, BOYNTON BEACH, FL, 334250550, US | 2300 SOUTH CONGRESS AVENUE SUITE 101, BOYNTON BEACH, FL, 33426, US | |||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 561-374-8919 |
| Fax | 5813748911 |
| Phone | +1 561-374-8911 |
| Fax | 5613748911 |
Authorized person
| Name | FREDERICK TACKEY |
| Role | MANAGING MEMBER |
| Phone | 5613748919 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | 0068055 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 207RC0200X - Critical Care Medicine (Internal Medicine) Physician |
| License Number | 0068055 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 207RP1001X - Pulmonary Disease Physician |
| License Number | 0068055 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 377890800 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BANDOH JACQUELINE | Agent | 10849 LAKE WYNDS CT, BOYNTON BEACH, FL, 33437 |
| Name | Role | Address |
|---|---|---|
| TACKEY FREDERICK | Managing Member | 2300 SOUTH CONGRESS AVENUE SUITE 101, BOYNTON BEACH, FL, 33426 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2006-02-10 | 10849 LAKE WYNDS CT, BOYNTON BEACH, FL 33437 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2005-02-18 | 2300 SOUTH CONGRESS AVENUE, SUITE 101, BOYNTON BEACH, FL 33426 | No data |
| CHANGE OF MAILING ADDRESS | 2002-03-05 | 2300 SOUTH CONGRESS AVENUE, SUITE 101, BOYNTON BEACH, FL 33426 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-29 |
| ANNUAL REPORT | 2024-02-01 |
| ANNUAL REPORT | 2023-01-22 |
| ANNUAL REPORT | 2022-01-26 |
| ANNUAL REPORT | 2021-01-09 |
| ANNUAL REPORT | 2020-02-01 |
| ANNUAL REPORT | 2019-02-13 |
| ANNUAL REPORT | 2018-01-25 |
| ANNUAL REPORT | 2017-02-15 |
| ANNUAL REPORT | 2016-03-09 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
