| Entity Name: | CENTER FOR ADVANCED GASTROENTEROLOGY, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 17 Sep 2004 (20 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 28 Mar 2018 (7 years ago) |
| Document Number: | L04000069133 |
| FEI/EIN Number | 54-2160614 |
| Address: | 740 S Concourse Pkwy, SUITE #200, MAITLAND, FL 32751 |
| Mail Address: | 740 S Concourse Pkwy, SUITE #200, MAITLAND, FL 32751 |
| ZIP code: | 32751 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1811998891 | 2005-08-02 | 2022-07-21 | 260 LOOKOUT PL, STE 201, MAITLAND, FL, 327514485, US | 260 LOOKOUT PL, STE 201, MAITLAND, FL, 327514485, US | |||||||||||||||||||||||||||||
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| Phone | +1 407-644-4014 |
| Fax | 4076445270 |
Authorized person
| Name | NADIA A HILAL |
| Role | ADMINISTRATOR |
| Phone | 4076444222 |
Taxonomy
| Taxonomy Code | 207RG0100X - Gastroenterology Physician |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 271940100 |
| State | FL |
| Issuer | BCBS GROUP PIN |
| Number | 74539 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Sturm, Angie | Agent | 740 S Concourse Pkwy, Suite 200, MAITLAND, FL 32751 |
| Name | Role | Address |
|---|---|---|
| HILAL, RAOUF MD | Manager | 740 S Concourse Pkwy, Suite 200 MAITLAND, FL 32751 |
| Name | Role | Address |
|---|---|---|
| MUSHAHWAR, ANDRIA MMD | Managing Member | 740 S Concourse Pkwy, Suite 200 MAITLAND, FL 32751 |
| QUAGLIATA, JOSEPH JMD | Managing Member | 740 S Concourse Pkwy, Suite 200 MAITLAND, FL 32751 |
| Name | Role | Address |
|---|---|---|
| Sturm, Angie | Administrator | 740 S Concourse Pkwy, Suite 200 MAITLAND, FL 32751 |
| Name | Role | Address |
|---|---|---|
| Panzarella, Paul, Dr. | Authorized Member | 740 S Concourse Pkwy, SUITE #200 MAITLAND, FL 32751 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2023-02-02 | Sturm, Angie | No data |
| LC AMENDMENT | 2018-03-28 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2018-03-27 | 740 S Concourse Pkwy, Suite 200, MAITLAND, FL 32751 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2018-03-27 | 740 S Concourse Pkwy, SUITE #200, MAITLAND, FL 32751 | No data |
| CHANGE OF MAILING ADDRESS | 2018-03-27 | 740 S Concourse Pkwy, SUITE #200, MAITLAND, FL 32751 | No data |
| REINSTATEMENT | 2017-10-02 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2017-09-22 | No data | No data |
| LC NAME CHANGE | 2016-08-30 | CENTER FOR ADVANCED GASTROENTEROLOGY, LLC | No data |
| AMENDED AND RESTATEDARTICLES/NAME CHANGE | 2005-05-23 | CENTER FOR ADVANCED GASTROENTEROLOGY, PLLC | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-11 |
| ANNUAL REPORT | 2023-02-02 |
| ANNUAL REPORT | 2022-01-06 |
| ANNUAL REPORT | 2021-01-10 |
| ANNUAL REPORT | 2020-01-16 |
| ANNUAL REPORT | 2019-04-09 |
| ANNUAL REPORT | 2018-03-27 |
| REINSTATEMENT | 2017-10-02 |
| LC Name Change | 2016-08-30 |
| ANNUAL REPORT | 2016-01-25 |
Date of last update: 05 Jan 2025
Sources: Florida Department of State
