| Entity Name: | PEDIATRIC MD SERVICES, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 10 Feb 2006 (19 years ago) |
| Date of dissolution: | 25 Sep 2009 (15 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 25 Sep 2009 (15 years ago) |
| Document Number: | L06000015087 |
| FEI/EIN Number | 562559524 |
| Address: | 1325 S. CONGRESS AVENUE, SUITE 109, BOYNTON BEACH, FL, 33426, US |
| Mail Address: | 1325 S. CONGRESS AVENUE, SUITE 109, BOYNTON BEACH, FL, 33426, US |
| ZIP code: | 33426 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1336328046 | 2007-10-30 | 2008-09-21 | 1325 S CONGRESS AVE, SUITE 109, BOYNTON BEACH, FL, 334265876, US | 1325 S CONGRESS AVE, SUITE 109, BOYNTON BEACH, FL, 334265876, US | |||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||
| Phone | +1 561-736-2510 |
| Fax | 5615034873 |
Authorized person
| Name | SUZANNE PAVLOU |
| Role | PRESIDENT/CEO |
| Phone | 5617362510 |
Taxonomy
| Taxonomy Code | 208000000X - Pediatrics Physician |
| License Number | ME90011 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 270305000 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| PAVLOU SUZANNE M | Agent | 1325 S. CONGRESS AVENUE, BOYNTON BEACH, FL, 33426 |
| Name | Role | Address |
|---|---|---|
| PAVLOU SUZANNE M | Manager | 1325 S. CONGRESS AVE, STE 109, BOYNTON BEACH, FL, 33426 |
| Name | Role | Address |
|---|---|---|
| PAVLOU SUZANNE M | Director | 1325 S. CONGRESS AVE, STE 109, BOYNTON BEACH, FL, 33426 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2009-09-25 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2008-06-01 | 1325 S. CONGRESS AVENUE, SUITE 109, BOYNTON BEACH, FL 33426 | No data |
| CHANGE OF MAILING ADDRESS | 2008-06-01 | 1325 S. CONGRESS AVENUE, SUITE 109, BOYNTON BEACH, FL 33426 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2008-06-01 | 1325 S. CONGRESS AVENUE, SUITE 109, BOYNTON BEACH, FL 33426 | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J10000517646 | ACTIVE | 1000000164388 | PALM BEACH | 2010-03-12 | 2030-04-21 | $ 2,616.84 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, WEST PALM BEACH SERVICE CENTER, 2468 METROCENTRE BLVD, WEST PALM BEACH FL334073105 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2008-06-01 |
| ANNUAL REPORT | 2007-04-30 |
| Florida Limited Liability | 2006-02-10 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
