| Entity Name: | MEDI MD, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 26 Jun 2007 (18 years ago) |
| Date of dissolution: | 25 Sep 2020 (4 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 25 Sep 2020 (4 years ago) |
| Document Number: | L07000067071 |
| FEI/EIN Number | 260765834 |
| Address: | 7950 SW 30th Street, DAVIE, FL, 33328, US |
| Mail Address: | 7950 SW 30th Street, DAVIE, FL, 33328, US |
| ZIP code: | 33328 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1306094586 | 2008-08-31 | 2022-07-21 | 7950 SW 30TH ST STE 200, DAVIE, FL, 333281979, US | 7950 SW 30TH ST STE 200, DAVIE, FL, 333281979, US | |||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 888-674-0160 |
| Fax | 8664671802 |
| Fax | 8884671802 |
Authorized person
| Name | SEBASTIAN AHMED |
| Role | EXEC |
| Phone | 8886740160 |
Taxonomy
| Taxonomy Code | 261QM1300X - Multi-Specialty Clinic/Center |
| License Number | 602238 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 261QR0405X - Substance Use Disorder Rehabilitation Clinic/Center |
| License Number | 0601 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | RR MEDICARE |
| Number | DQ5523 |
| State | FL |
| Issuer | MEDICAID |
| Number | 001991000 |
| State | FL |
| Issuer | BCBS |
| Number | 98322 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| STUART A. TELLER, ESQ | Agent | 7320 GRIFFIN ROAD SUITE 216, DAVIE, FL, 33314 |
| Name | Role | Address |
|---|---|---|
| AHMED SEBASTIAN | President | 7950 SW 30th Street, Davie, FL, 33328 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G18000080004 | SERENITY RECOVERY CENTERS | EXPIRED | 2018-07-25 | 2023-12-31 | No data | 7950 SW 30TH STREET, SUITE 200, DAVIE, FL, 33328 |
| G17000112408 | SERENITY TREATMENT CENTERS | EXPIRED | 2017-10-11 | 2022-12-31 | No data | 7950 SW 30TH STREET, SUITE 200, DAVIE, FL, 33328 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2020-09-25 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2019-04-09 | 7320 GRIFFIN ROAD SUITE 216, DAVIE, FL 33314 | No data |
| REGISTERED AGENT NAME CHANGED | 2019-04-09 | STUART A. TELLER, ESQ | No data |
| REINSTATEMENT | 2018-11-20 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2018-09-28 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2017-10-10 | 7950 SW 30th Street, Suite 200, DAVIE, FL 33328 | No data |
| REINSTATEMENT | 2017-10-10 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2017-10-10 | 7950 SW 30th Street, Suite 200, DAVIE, FL 33328 | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2017-09-22 | No data | No data |
| LC AMENDMENT | 2016-07-14 | No data | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J21000095491 | ACTIVE | 1000000878393 | BROWARD | 2021-02-24 | 2031-03-03 | $ 1,017.15 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, WEST PALM BEACH SERVICE CENTER, 2468 METROCENTRE BLVD, WEST PALM BEACH FL334073105 |
| J11000502695 | TERMINATED | SP11-0638 | ST. JOHNS COUNTY COURT | 2011-07-27 | 2016-08-09 | $3696.63 | PSS WORLD MEDICAL, INC., C/O WILLIAM M. LINDEMAN, P.A., POST OFFICE BOX 3506, ORLANDO, FL 32802 |
| Name | Date |
|---|---|
| AMENDED ANNUAL REPORT | 2019-04-09 |
| ANNUAL REPORT | 2019-03-22 |
| REINSTATEMENT | 2018-11-20 |
| REINSTATEMENT | 2017-10-10 |
| LC Amendment | 2016-07-14 |
| REINSTATEMENT | 2016-04-07 |
| ANNUAL REPORT | 2014-01-26 |
| ANNUAL REPORT | 2013-06-11 |
| ANNUAL REPORT | 2012-04-12 |
| ANNUAL REPORT | 2011-04-20 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
