| Entity Name: | LAKE COUNTY PRIMARY MEDICAL CARE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 12 Aug 2005 (20 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 05 Dec 2012 (12 years ago) |
| Document Number: | L05000079696 |
| FEI/EIN Number | 841688762 |
| Address: | 1866 Mayo Drive, Tavares, FL, 32778, US |
| Mail Address: | 1866 Mayo Drive, Tavares, FL, 32778, US |
| ZIP code: | 32778 |
| County: | Lake |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1568451888 | 2005-10-19 | 2012-12-31 | 33 N CENTER ST, SUITE A, EUSTIS, FL, 327263580, US | 33 N CENTER ST, SUITE A, EUSTIS, FL, 327263580, US | |||||||||||||||||||||
|
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| Phone | +1 352-357-0880 |
| Fax | 3523570334 |
Authorized person
| Name | MRS. SUJATHA BASKAR |
| Role | OWNER |
| Phone | 3523570880 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 274014100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BASKAR SUJATHA M | Agent | 1866 MayoDrive, Tavares, FL, 32778 |
| Name | Role | Address |
|---|---|---|
| BASKAR SUJATHA | Manager | 1866 Mayo Drive, Tavares, FL, 32778 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2015-02-23 | 1866 Mayo Drive, Tavares, FL 32778 | No data |
| CHANGE OF MAILING ADDRESS | 2015-02-23 | 1866 Mayo Drive, Tavares, FL 32778 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2015-02-23 | 1866 MayoDrive, Tavares, FL 32778 | No data |
| LC AMENDMENT | 2012-12-05 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2012-12-05 | BASKAR, SUJATHA M.D. | No data |
| NAME CHANGE AMENDMENT | 2005-08-25 | LAKE COUNTY PRIMARY MEDICAL CARE, LLC | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-22 |
| ANNUAL REPORT | 2023-03-06 |
| ANNUAL REPORT | 2022-05-25 |
| ANNUAL REPORT | 2021-03-14 |
| ANNUAL REPORT | 2020-03-07 |
| ANNUAL REPORT | 2019-04-04 |
| ANNUAL REPORT | 2018-03-24 |
| ANNUAL REPORT | 2017-04-28 |
| ANNUAL REPORT | 2016-02-01 |
| ANNUAL REPORT | 2015-02-23 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
