| Entity Name: | KIDNEY SPECIALISTS OF THE PALM BEACHES LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 29 Dec 2004 (20 years ago) |
| Document Number: | L04000094194 |
| FEI/EIN Number | 20-2069671 |
| Address: | 11301 OKEECHOBEE BLVD, SUITE 5A, ROYAL PALM BEACH, FL 33411 |
| Mail Address: | 11301 OKEECHOBEE BLVD, SUITE 5A, ROYAL PALM BEACH, FL 33411 |
| ZIP code: | 33411 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1871609578 | 2006-08-22 | 2015-03-02 | 11301 OKEECHOBEE BLVD, SUITE 5A, ROYAL PALM BEACH, FL, 33411, US | 11301 OKEECHOBEE BLVD, SUITE 5A, ROYAL PALM BEACH, FL, 33411, US | |||||||||||||||||||||||||||||||
|
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| Phone | +1 561-283-0384 |
| Fax | 5612823238 |
Authorized person
| Name | MOHAN ISAAC ABRAHAM |
| Role | MANAGER |
| Phone | 5618684846 |
Taxonomy
| Taxonomy Code | 173000000X - Legal Medicine |
| License Number | ME83538 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 271936300 |
| State | FL |
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | 94755 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| ABRAHAM, MOHAN ISAAC | Agent | 11301 OKEECHOBEE BLVD,, SUITE 5A, ROYAL PALM BEACH, FL 33411 |
| Name | Role |
|---|---|
| PALM BEACH KIDNEY CARE, LLC | manager |
| Name | Role | Address |
|---|---|---|
| ABRAHAM MEDICAL ASSOCIATES PA | Manager | 11301 OKEECHOBEE BLVD, SUITE 5A,, ROYAL PALM BEACH, FL 33411 |
| KIDNEY, HYPERTENSION & IM SPECIALISTS LLC | Manager | 6567 DUCKWEED ROAD, LAKEWORTH, FL 33426 |
| RENAL ASSOCIATES OF FLORIDA, PLLC | Manager | No data |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2010-04-25 | 11301 OKEECHOBEE BLVD, SUITE 5A, ROYAL PALM BEACH, FL 33411 | No data |
| CHANGE OF MAILING ADDRESS | 2010-04-25 | 11301 OKEECHOBEE BLVD, SUITE 5A, ROYAL PALM BEACH, FL 33411 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2010-04-25 | 11301 OKEECHOBEE BLVD,, SUITE 5A, ROYAL PALM BEACH, FL 33411 | No data |
| REGISTERED AGENT NAME CHANGED | 2009-01-21 | ABRAHAM, MOHAN ISAAC | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-27 |
| ANNUAL REPORT | 2023-04-27 |
| ANNUAL REPORT | 2022-04-29 |
| ANNUAL REPORT | 2021-04-30 |
| ANNUAL REPORT | 2020-04-29 |
| ANNUAL REPORT | 2019-04-22 |
| ANNUAL REPORT | 2018-04-27 |
| ANNUAL REPORT | 2017-04-28 |
| ANNUAL REPORT | 2016-04-27 |
| ANNUAL REPORT | 2015-04-26 |
Date of last update: 04 Jan 2025
Sources: Florida Department of State
