| Entity Name: | SUNSHINE WALK-IN CLINIC, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 18 Aug 2004 (20 years ago) |
| Date of dissolution: | 23 May 2006 (19 years ago) |
| Last Event: | CONVERSION |
| Event Date Filed: | 23 May 2006 (19 years ago) |
| Document Number: | L04000061222 |
| FEI/EIN Number | 201506230 |
| Address: | 5205 BABCOCK STREET NE, SUITE 3, PALM BAY, FL, 32905, US |
| Mail Address: | 5205 BABCOCK STREET NE, SUITE 3, PALM BAY, FL, 32905, US |
| ZIP code: | 32905 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1790948941 | 2008-07-08 | 2008-07-08 | 5205 BABCOCK ST NE, SUITE 3, PALM BAY, FL, 329054638, US | 5205 BABCOCK ST NE, SUITE 3, PALM BAY, FL, 329054638, US | |||||||||||||||||||||||||||
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| Phone | +1 321-729-1400 |
| Fax | 3217285700 |
Authorized person
| Name | DR. NAGEH S. BARSOUM |
| Role | PRESIDENT |
| Phone | 3217291400 |
Taxonomy
| Taxonomy Code | 208D00000X - General Practice Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 264156900 |
| State | FL |
| Issuer | MEDICAID |
| Number | 264156901 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BARSOUM NAGEH M | Agent | 1572 LARAMIE CIR., MELBOURNE, FL, 32940 |
| Name | Role | Address |
|---|---|---|
| BARSOUM NAGEH S | Managing Member | 1572 LARAMIE CIRCLE, MELBOURNE, FL, 32940 |
| BARSOUM WARDA K | Managing Member | 1572 LARAMIE CIRCLE, MELBOURNE, FL, 32940 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CONVERSION | 2006-05-23 | No data | CONVERSION MEMBER. RESULTING CORPORATION WAS P06000071535. CONVERSION NUMBER 700000057387 |
| REGISTERED AGENT NAME CHANGED | 2005-07-15 | BARSOUM, NAGEH MD | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2005-07-15 | 1572 LARAMIE CIR., MELBOURNE, FL 32940 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2006-01-27 |
| Reg. Agent Change | 2005-07-15 |
| ANNUAL REPORT | 2005-01-11 |
| Florida Limited Liability | 2004-08-18 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
