| Entity Name: | SEBRING PEDIATRICS, L.L.C. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 02 Jun 2006 (19 years ago) |
| Last Event: | LC STMNT OF RA/RO CHG |
| Event Date Filed: | 08 Sep 2020 (4 years ago) |
| Document Number: | L06000057653 |
| FEI/EIN Number | 593314618 |
| Address: | 3201 MEDICAL WAY, SUITE 101, SEBRING, FL, 33870, US |
| Mail Address: | 3201 MEDICAL WAY, SUITE 101, SEBRING, FL, 33870, US |
| ZIP code: | 33870 |
| County: | Highlands |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1255492096 | 2006-12-13 | 2020-07-30 | 3201 MEDICAL WAY, SUITE 101, SEBRING, FL, 338705412, US | 3201 MEDICAL WAY, SUITE 101, SEBRING, FL, 338705412, US | |||||||||||||||||||||||||||||||||||||
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| Phone | +1 863-382-0770 |
| Fax | 8634719968 |
Authorized person
| Name | PRAVEEN KRISHNADAS |
| Role | MEDICAL DIRECTOR AND MANAGER |
| Phone | 8633820770 |
Taxonomy
| Taxonomy Code | 208000000X - Pediatrics Physician |
| Is Primary | Yes |
| Taxonomy Code | 261QR1300X - Rural Health Clinic/Center |
| Is Primary | No |
Other Provider Identifiers
| Issuer | BLUECROSS BLUE SHIELD OF |
| Number | 33877 |
| State | FL |
| Issuer | MEDICAID |
| Number | 377682400 |
| State | FL |
| Issuer | MEDICAID |
| Number | 377682401 |
| State | FL |
| Name | Role |
|---|---|
| DEAN MEAD SERVICES, LLC | Agent |
| Name | Role | Address |
|---|---|---|
| M.D. PRAVEEN K | Manager | 3201 MEDICAL WAY, SEBRING, FL, 33870 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2020-09-08 | DEAN MEAD SERVICES, LLC | No data |
| LC STMNT OF RA/RO CHG | 2020-09-08 | No data | No data |
| LC AMENDMENT | 2017-06-15 | No data | No data |
| LC STMNT OF RA/RO CHG | 2016-12-15 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2016-12-15 | 420 S. ORANGE AVENUE, SUITE 700, ORLANDO, FL 32801 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2010-04-16 | 3201 MEDICAL WAY, SUITE 101, SEBRING, FL 33870 | No data |
| CHANGE OF MAILING ADDRESS | 2010-04-16 | 3201 MEDICAL WAY, SUITE 101, SEBRING, FL 33870 | No data |
| CONVERSION | 2006-06-02 | No data | CORPORATION WAS A CONVERSION RESULT. CONVERTING CORPORATION WAS P95000040727. CONVERSION NUMBER 300000057593 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-05 |
| ANNUAL REPORT | 2024-01-06 |
| ANNUAL REPORT | 2023-01-08 |
| ANNUAL REPORT | 2022-01-05 |
| ANNUAL REPORT | 2021-01-10 |
| CORLCRACHG | 2020-09-08 |
| ANNUAL REPORT | 2020-01-05 |
| ANNUAL REPORT | 2019-01-13 |
| ANNUAL REPORT | 2018-01-14 |
| LC Amendment | 2017-06-15 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
