| Entity Name: | MPM SPECIALISTS LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 01 Feb 2005 (20 years ago) |
| Date of dissolution: | 27 Dec 2017 (7 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 27 Dec 2017 (7 years ago) |
| Document Number: | L05000010608 |
| FEI/EIN Number | 300305109 |
| Address: | 300 SOUTH PARK PLACE BOULEVARD, SUITE 180, CLEARWATER, FL, 33759, US |
| Mail Address: | 300 SOUTH PARK PLACE BOULEVARD, SUITE 180, CLEARWATER, FL, 33759, US |
| ZIP code: | 33759 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 1851346829 | 2006-05-24 | 2015-02-14 | PO BOX 10744, CLEARWATER, FL, 337578744, US | 300 PARK PLACE BLVD, SUITE 170, CLEARWATER, FL, 337594932, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 727-532-0002 |
| Fax | 7272664928 |
| Phone | +1 727-532-1355 |
Authorized person
| Name | MR. KEVIN L. CORRIGAN |
| Role | CAO |
| Phone | 7275321355 |
Taxonomy
| Taxonomy Code | 103TC0700X - Clinical Psychologist |
| Is Primary | No |
| Taxonomy Code | 133V00000X - Registered Dietitian |
| Is Primary | No |
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 207RC0000X - Cardiovascular Disease Physician |
| Is Primary | No |
| Taxonomy Code | 207RE0101X - Endocrinology, Diabetes & Metabolism Physician |
| Is Primary | No |
| Taxonomy Code | 207T00000X - Neurological Surgery Physician |
| Is Primary | No |
| Taxonomy Code | 207V00000X - Obstetrics & Gynecology Physician |
| Is Primary | No |
| Taxonomy Code | 2084N0400X - Neurology Physician |
| Is Primary | No |
| Taxonomy Code | 208600000X - Surgery Physician |
| Is Primary | Yes |
| Taxonomy Code | 2086S0129X - Vascular Surgery Physician |
| Is Primary | No |
| Taxonomy Code | 208G00000X - Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician |
| Is Primary | No |
| Taxonomy Code | 363A00000X - Physician Assistant |
| Is Primary | No |
| Taxonomy Code | 363L00000X - Nurse Practitioner |
| Is Primary | No |
Other Provider Identifiers
| Issuer | RAILROAD MEDICARE NUMBER |
| Number | DD7747 |
| State | FL |
| Issuer | MEDICAID |
| Number | 275066000 |
| State | FL |
| Name | Role |
|---|---|
| BAYCARE HEALTH SYSTEM, INC. | Agent |
| Name | Role | Address |
|---|---|---|
| Ulbricht William | Secretary | 300 SOUTH PARK PLACE BOULEVARD, CLEARWATER, FL, 33759 |
| Name | Role | Address |
|---|---|---|
| Fink Andrew M.D. | Director | 4902 EISENHOWER BOULEVARD, TAMPA, FL, 33634 |
| FLAREAU BRUCE M.D. | Director | 2985 DREW STREET, CLEARWATER, FL, 33759 |
| WATERS GLENN | Director | 2985 DREW STREET, CLEARWATER, FL, 33759 |
| BORRECA JOHN | Director | 5405 SUNFLARE WEST, LUTZ, FL, 33558 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G14000129654 | BAYCARE MEDICAL GROUP | EXPIRED | 2014-12-24 | 2024-12-31 | No data | 3503 E. FRONTAGE ROAD, TAMPA, FL, 33607 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2017-12-27 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2016-03-07 | BAYCARE HEALTH SYSTEM, INC. | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2014-04-28 | ATTENTION: LEGAL SERVICES DEPARTMENT, 2985 DREW STREET, CLEARWATER, FL 33759 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2014-04-28 | 300 SOUTH PARK PLACE BOULEVARD, SUITE 180, CLEARWATER, FL 33759 | No data |
| CHANGE OF MAILING ADDRESS | 2014-04-28 | 300 SOUTH PARK PLACE BOULEVARD, SUITE 180, CLEARWATER, FL 33759 | No data |
| LC AMENDMENT | 2009-05-15 | No data | No data |
| NAME CHANGE AMENDMENT | 2005-08-26 | MPM SPECIALISTS LLC | No data |
| NAME CHANGE AMENDMENT | 2005-03-11 | MORTON PLANT MEASE SPECIALISTS, LLC | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2017-04-27 |
| AMENDED ANNUAL REPORT | 2016-08-15 |
| ANNUAL REPORT | 2016-03-07 |
| ANNUAL REPORT | 2015-03-04 |
| ANNUAL REPORT | 2014-04-28 |
| ANNUAL REPORT | 2013-02-19 |
| ANNUAL REPORT | 2012-03-20 |
| ANNUAL REPORT | 2011-04-18 |
| ANNUAL REPORT | 2010-03-31 |
| LC Amendment | 2009-05-15 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
