| Entity Name: | SUNCOAST PREMIER MEDICAL, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 11 Mar 2008 (17 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 12 Jan 2011 (14 years ago) |
| Document Number: | L08000025303 |
| FEI/EIN Number | 223977314 |
| Mail Address: | PO BOX 470459, CELEBRATION, FL, 34747 |
| Address: | 1714 US Highway 27, suite 15, CLERMONT, FL, 34714, US |
| ZIP code: | 34714 |
| County: | Lake |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1427206739 | 2008-08-29 | 2018-11-13 | PO BOX 470459, CELEBRATION, FL, 34747, US | 1239 US HIGHWAY 27, CLERMONT, FL, 347148910, US | |||||||||||||||||||||||||
|
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| Phone | +1 352-243-3555 |
| Fax | 3522436614 |
Authorized person
| Name | MARIO RENE PEREZ |
| Role | OWNER |
| Phone | 8632076554 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | ME72969 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 277533600 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MARIO R. PEREZ | Agent | 7709 Sundial LN, Orlando, FL, 32819 |
| Name | Role | Address |
|---|---|---|
| PEREZ MARIO R | President | 1239 HIGHWAY 27, CLERMONT, FL, 34714 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-04-13 | 1714 US Highway 27, suite 15, CLERMONT, FL 34714 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-04-09 | 7709 Sundial LN, Orlando, FL 32819 | No data |
| CHANGE OF MAILING ADDRESS | 2012-03-21 | 1714 US Highway 27, suite 15, CLERMONT, FL 34714 | No data |
| REINSTATEMENT | 2011-01-12 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2010-09-24 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2009-06-12 | MARIO R. PEREZ | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-13 |
| ANNUAL REPORT | 2023-04-09 |
| ANNUAL REPORT | 2022-03-05 |
| ANNUAL REPORT | 2021-04-09 |
| ANNUAL REPORT | 2020-05-07 |
| ANNUAL REPORT | 2019-04-14 |
| ANNUAL REPORT | 2018-01-30 |
| ANNUAL REPORT | 2017-03-13 |
| ANNUAL REPORT | 2016-02-20 |
| ANNUAL REPORT | 2015-03-24 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
