| Entity Name: | INNOVATIVE ORTHOTICS & PROSTHETICS, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 16 Jan 2007 (18 years ago) |
| Date of dissolution: | 23 Sep 2011 (13 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 23 Sep 2011 (13 years ago) |
| Document Number: | L07000005592 |
| FEI/EIN Number | 208337459 |
| Address: | 537 US HIGHWAY ONE, SUITE 6, NORTH PALM BEACH, FL, 33408 |
| Mail Address: | 537 US HIGHWAY ONE, SUITE 6, NORTH PALM BEACH, FL, 33408 |
| ZIP code: | 33408 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1306043625 | 2007-06-29 | 2010-08-02 | 537 US HIGHWAY 1, SUITE 6, NORTH PALM BEACH, FL, 334084903, US | 537 US HIGHWAY 1, SUITE 6, NORTH PALM BEACH, FL, 334084903, US | |||||||||||||||||||||||||||||||||||||||
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| Phone | +1 561-296-2000 |
| Fax | 5612969912 |
Authorized person
| Name | MR. ANDREW D DOMB |
| Role | OWNER |
| Phone | 5612962000 |
Taxonomy
| Taxonomy Code | 222Z00000X - Orthotist |
| License Number | POR188 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 224P00000X - Prosthetist |
| License Number | POR188 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 032644500 |
| State | FL |
| Issuer | BCBSFL |
| Number | M2829 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| DOMB ANDREW D | Agent | 1614 16TH LANE, PALM BEACH GARDENS, FL, 33418 |
| Name | Role | Address |
|---|---|---|
| DOMB ANDREW D | Manager | 1614 16TH LANE, PALM BEACH GARDENS, FL, 33418 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2011-09-23 | No data | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J13000654435 | ACTIVE | 1000000414956 | PALM BEACH | 2013-01-03 | 2033-04-04 | $ 378.11 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, OUT OF STATE COLLECTIONS UNIT, 1401 W US HIGHWAY 90 STE 100, LAKE CITY FL320556123 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2010-01-11 |
| ANNUAL REPORT | 2009-05-14 |
| ANNUAL REPORT | 2008-07-07 |
| Florida Limited Liability | 2007-01-16 |
| Contract Type | Award or IDV Flag | PIID | Start Date | Current End Date | Potential End Date | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| No data | IDV | VA248BP008831 | 2008-10-01 | No data | No data | |||||||||||||||||||||||
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| Obligated Amount | 0.00 |
| Potential Award Amount | 0.00 |
Description
| Title | PROSTHETIC FABRICATION AND REPAIR |
| NAICS Code | 339113: SURGICAL APPLIANCE AND SUPPLIES MANUFACTURING |
| Product and Service Codes | 6515: MED & SURGICAL INSTRUMENTS,EQ & SUP |
Recipient Details
| Recipient | INNOVATIVE ORTHOTICS & PROSTHETICS, LLC |
| UEI | TMG4PVL3FLL6 |
| Recipient Address | 537 US HWY 1 STE 6, NORTH PALM BEACH, PALM BEACH, FLORIDA, 334084903, UNITED STATES |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
