| Entity Name: | GARCIA MEDICAL CLINIC, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 29 Nov 2006 (18 years ago) |
| Document Number: | L06000114411 |
| FEI/EIN Number | 205957163 |
| Address: | 411 E. NELSON AVE., DEFUNIAK SPGS, FL, 32433, US |
| Mail Address: | 411 E. NELSON AVE., DEFUNIAK SPGS, FL, 32433, US |
| ZIP code: | 32433 |
| County: | Walton |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1407971922 | 2007-03-21 | 2017-06-19 | 411 E NELSON AVE, DEFUNIAK SPRINGS, FL, 324337444, US | 411 E NELSON AVE, DEFUNIAK SPRINGS, FL, 324337444, US | |||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 850-892-4791 |
| Fax | 8508923868 |
Authorized person
| Name | MR. RUBEN RUIZ GARCIA JR. |
| Role | PHYSICIAN/OWNER |
| Phone | 8508924791 |
Taxonomy
| Taxonomy Code | 208D00000X - General Practice Physician |
| License Number | ME59559 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 261Q00000X - Clinic/Center |
| License Number | ME59559 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 052715700 |
| State | FL |
| Issuer | BLUE CROSS-BLUE SHIELD |
| Number | 11921 |
| State | FL |
| Issuer | COMMERCIAL BILLING |
| Number | ME59559 |
| State | FL |
| Issuer | MEDICAID |
| Number | 660200200 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| GARCIA RUBEN R | Agent | 520 MCCOULLOUGH RD., DEFUNIAK SPGS, FL, 32433 |
| Name | Role | Address |
|---|---|---|
| GARCIA RUBEN R | Manager | 520 MCCOULLOUGH RD., DEFUNIAK SPG, FL, 32433 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-19 |
| ANNUAL REPORT | 2023-01-23 |
| ANNUAL REPORT | 2022-04-28 |
| ANNUAL REPORT | 2021-04-23 |
| ANNUAL REPORT | 2020-01-13 |
| ANNUAL REPORT | 2019-02-18 |
| ANNUAL REPORT | 2018-02-07 |
| ANNUAL REPORT | 2017-01-17 |
| ANNUAL REPORT | 2016-03-03 |
| ANNUAL REPORT | 2015-03-13 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
