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  5. VITALMD GROUP HOLDING, LLC

VITALMD GROUP HOLDING, LLC

Company Details

Entity Name: VITALMD GROUP HOLDING, LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Active
Date Filed: 19 Sep 2003 (21 years ago)
Last Event: LC AMENDMENT
Event Date Filed: 22 Apr 2024 (9 months ago)
Document Number: L03000036510
FEI/EIN Number 542129332
Address: 3225 AVIATION AVENUE, SUITE 700, COCONUT GROVE, FL, 33133, US
Mail Address: P.O. BOX 43-2040, MIAMI, FL, 33243-2040
ZIP code: 33133
County: Miami-Dade
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1043984941 2021-08-04 2021-08-04 3225 AVIATION AVE FL 4, MIAMI, FL, 331334741, US 3225 AVIATION AVE FL 4, MIAMI, FL, 331334741, US

Contacts
Phone +1 305-273-4641
Fax 3056317680

Authorized person
Name MS. JESSICA CAPOTE
Role MANAGED CARE DIRECTOR
Phone 3052734641

Taxonomy
Taxonomy Code 101Y00000X - Counselor
Is Primary No
Taxonomy Code 103TF0000X - Family Psychologist
Is Primary No
Taxonomy Code 104100000X - Social Worker
Is Primary No
Taxonomy Code 106H00000X - Marriage & Family Therapist
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 269024100
State FL

Agent

Name Role Address
YELEN MITCHELL A Agent 3444 Main HWY., Miami, FL, 33133

President

Name Role Address
VIZOSO JAVIER M President 7300 SW 62ND PLACE, 3RD FLOOR, SOUTH MIAMI, FL, 33143

Exec

Name Role Address
SALKIND GLENN Exec 8950 SW 74th Court, MIAMI, FL, 33156

Vice President

Name Role Address
KUHN KERRY M Vice President 1725 N. UNIVERSITY DR., STE. 440, CORAL SPRINGS, FL, 33071
Grenitz Mark M Vice President 220 SW 84th Ave, Plantation, FL, 33324
ESSERMAN JAMES D Vice President 8950 SW 74th Court, MIAMI, FL, 33156

Secretary

Name Role Address
FIDALGO EDWARD MMD Secretary 3659 S MIAMI AVE, STE. 5005, MIAMI, FL, 33133

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G20000050040 BROWARD COMPLETE OB/GYN WELLNESS CENTER ACTIVE 2020-05-06 2025-12-31 No data 3225 AVIATION AVENUE, SUITE 700, MIAMI, FL, 33133
G20000049660 BERGMAN PEDIATRICS ACTIVE 2020-05-05 2025-12-31 No data 3225 AVIATION AVENUE, SUITE 700, MIAMI, FL, 33133
G20000009425 GUILLERMO RUIZ, MD, LLC ACTIVE 2020-01-21 2025-12-31 No data 3225 AVIATION AVENUE, SUITE 700, MIAMI, FL, 33133
G20000006177 BROWARD COMPLETE OB/GYN WELLNESS CENTER, LLC ACTIVE 2020-01-14 2025-12-31 No data 3225 AVIATION AVENUE, SUITE 700, MIAMI, FL, 33133
G20000001448 GEMINI OBSTETRICS/GYNECOLOGY, LLC ACTIVE 2020-01-04 2025-12-31 No data 3225 AVIATION AVENUE, SUITE 700, MIAMI, FL, 33133
G19000073224 BREAST CARE CENTER MIAMI EXPIRED 2019-07-02 2024-12-31 No data 3225 AVIATION AVENUE, SUITE 700, MIAMI, FL, 33134
G19000063922 SAWGRASS WOMEN'S CENTER EXPIRED 2019-06-03 2024-12-31 No data 3225 AVIATION AVENUE, SUITE 700, MIAMI, FL, 33131
G19000061624 BERGMAN PEDIATRICS EXPIRED 2019-05-24 2024-12-31 No data 3225 AVIATION AVENUE, SUITE 700, MIAMI, FL, 33131
G18000071554 GREEN OB/GYN, ASSOCIATES EXPIRED 2018-06-26 2023-12-31 No data 3225 AVIATION AVENUE, SUITE 700, MIAMI, FL, 33133
G18000057696 WOMENS CARE OF BRADENTON EXPIRED 2018-05-10 2023-12-31 No data 3225 AVIATION AVENUE, SUITE 700, MIAMI, FL, 33133

Events

Event Type Filed Date Value Description
LC AMENDMENT 2024-04-22 No data No data
REGISTERED AGENT ADDRESS CHANGED 2024-02-02 3444 Main HWY., 2nd Floor, Miami, FL 33133 No data
LC AMENDMENT 2014-03-12 No data No data
LC AMENDMENT 2012-03-16 No data No data
LC AMENDMENT 2010-03-17 No data No data
CHANGE OF PRINCIPAL ADDRESS 2009-08-25 3225 AVIATION AVENUE, SUITE 700, COCONUT GROVE, FL 33133 No data
REGISTERED AGENT NAME CHANGED 2005-05-09 YELEN, MITCHELL A No data
CHANGE OF MAILING ADDRESS 2004-12-22 3225 AVIATION AVENUE, SUITE 700, COCONUT GROVE, FL 33133 No data

Debts

Document Number Status Case Number Name of Court Date of Entry Expiration Date Amount Due Plaintiff
J16000739916 TERMINATED 1000000726978 BROWARD 2016-11-14 2036-11-16 $ 14,978.32 STATE OF FLORIDA, DEPARTMENT OF REVENUE, OUT OF STATE COLLECTIONS UNIT, 1415 W US HIGHWAY 90 STE 115, LAKE CITY FL320556156
J13000958141 TERMINATED 1000000503218 LAKE 2013-05-10 2033-05-22 $ 4,861.69 STATE OF FLORIDA, DEPARTMENT OF REVENUE, LEESBURG SERVICE CENTER, 1904 THOMAS AVE STE 103, LEESBURG FL347483289

Documents

Name Date
LC Amendment 2024-04-22
ANNUAL REPORT 2024-02-02
ANNUAL REPORT 2023-03-16
ANNUAL REPORT 2022-02-28
ANNUAL REPORT 2021-05-13
ANNUAL REPORT 2020-04-01
ANNUAL REPORT 2019-02-12
AMENDED ANNUAL REPORT 2018-04-24
ANNUAL REPORT 2018-03-14
ANNUAL REPORT 2017-04-25

Related by officers

VIZOSO JAVIER M

FLORIDA WOMAN'S HEALTH CARE, INC.

SALKIND GLENN

PHYSICIAN QUALITY ALLIANCE OF FLORIDA, LLC GLENNSALKIND1599, INC.

YELEN MITCHELL A

GEMINI OB/GYN, LLC MIAMI HEART WELLNESS, LLC FLORIDA WOMEN'S HEALTH LLC ESSENCE OB/GYN, LLC SAWGRASS PEDIATRIC PARTNERS, LLC PEDIATRIC AND NEONATAL OF SOUTH FLORIDA, LLC MIAMI PEDIATRIC CARE, LLC THE ALLERGY INSTITUTE, LLC CIN GROUP HOLDINGS, LLC ADMIRAMD GROUP, LLC

Related by address

3225 AVIATION AVENUE, SUITE 700, COCONUT GROVE, FL, 33133, US

MASS SPORTS, LLC PREFERRED SITES, INC.

Date of last update: 01 Feb 2025

Sources: Florida Department of State

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