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PEDIATRIC ENT, LLC - Florida Company Profile

Company Details

Entity Name: PEDIATRIC ENT, LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.

PEDIATRIC ENT, LLC is structured as a Limited Liability Company (LLC), a common business structure that offers its members limited liability protection, separating their personal assets from the company's debts and obligations.
In Florida, LLCs are governed by Title XXXVI, Chapter 605, Florida Revised Limited Liability Company Act

Status: Active

The business entity is active. This status indicates that the business is currently operating and compliant with state regulations, suggesting a lower risk profile for lenders and potentially better creditworthiness.

Date Filed: 17 Nov 2008 (16 years ago)
Last Event: LC AMENDED/RESTATED ARTICLE/NAME CHANGE
Event Date Filed: 14 Feb 2012 (13 years ago)
Document Number: L08000106611
FEI/EIN Number 263957831

Federal Employer Identification (FEI) Number assigned by the IRS.

Address: 1499 S. HARBOUR CITY BLVD, SUITE 303, MELBOURNE, FL, 32901
Mail Address: 1499 S. HARBOUR CITY BLVD, SUITE 303, MELBOURNE, FL, 32901
ZIP code: 32901
County: Brevard
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1508002072 2009-01-05 2014-04-18 1499 S HARBOR CITY BLVD STE 303, MELBOURNE, FL, 329013245, US 1499 S HARBOR CITY BLVD STE 303, MELBOURNE, FL, 329013245, US

Contacts

Phone +1 321-254-5437
Fax 3212544543

Authorized person

Name DR. DAVID JOEL MALIS
Role MANAGER
Phone 3212545437

Taxonomy

Taxonomy Code 207YP0228X - Pediatric Otolaryngology Physician
License Number ME90348
State FL
Is Primary Yes

Other Provider Identifiers

Issuer MEDICAID HMO - AMERIGROUP
Number 01269821
State FL
Issuer MEDICAID HMO - UNITED HEALTH CARE
Number 2258392
State FL
Issuer MEDICAID HMO - WELLCARE
Number 332181
State FL
Issuer MEDICAID
Number 271247400
State FL

Key Officers & Management

Name Role Address
MALIS DAVID J Manager 290 LANSING ISLAND DR, SATELLITE BEACH, FL, 32937
Malis Cheryl L Vice President 1499 S. HARBOUR CITY BLVD, MELBOURNE, FL, 32901
NASH CHARLES IAN Agent C/O NASH & KROMASH, LLP, MELBOURNE, FL, 32901

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G21000164939 FAMILY ENT & AUDIOLOGY ACTIVE 2021-12-13 2026-12-31 - 1499 S HARBOR CITY BLVD STE 303, MELBOURNE, FL, 32901
G12000113090 FAMILY ENT & AUDIOLOGY EXPIRED 2012-11-26 2017-12-31 - 1499 S HARBOR CITY BLVD, SUITE 303, MELBOURNE, FL, 32901

Events

Event Type Filed Date Value Description
LC AMENDED AND RESTATED ARTICLES 2012-02-14 - -
LC AMENDED/RESTATED ARTICLE/NAME CHANGE 2012-02-14 PEDIATRIC ENT, LLC -
REGISTERED AGENT NAME CHANGED 2012-02-14 NASH, CHARLES IAN -
REGISTERED AGENT ADDRESS CHANGED 2012-02-14 C/O NASH & KROMASH, LLP, 440 SOUTH BABCOCK STREET, MELBOURNE, FL 32901 -
CHANGE OF PRINCIPAL ADDRESS 2010-02-16 1499 S. HARBOUR CITY BLVD, SUITE 303, MELBOURNE, FL 32901 -
CHANGE OF MAILING ADDRESS 2010-02-16 1499 S. HARBOUR CITY BLVD, SUITE 303, MELBOURNE, FL 32901 -

Documents

Name Date
ANNUAL REPORT 2025-02-23
ANNUAL REPORT 2024-01-07
ANNUAL REPORT 2023-01-22
ANNUAL REPORT 2022-02-10
AMENDED ANNUAL REPORT 2021-03-23
ANNUAL REPORT 2021-01-25
ANNUAL REPORT 2020-02-01
ANNUAL REPORT 2019-01-15
ANNUAL REPORT 2018-01-14
ANNUAL REPORT 2017-02-22

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
9514917005 2020-04-09 0455 PPP 1499 S Harbor City Blvd, Melbourne, FL, 32901-3210
Loan Status Date 2021-02-17
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 134064
Loan Approval Amount (current) 134064
Undisbursed Amount 0
Franchise Name -
Lender Location ID 17616
Servicing Lender Name Seacoast National Bank
Servicing Lender Address 815 Colorado Ave, STUART, FL, 34994-3053
Rural or Urban Indicator U
Hubzone Y
LMI Y
Business Age Description Existing or more than 2 years old
Project Address Melbourne, BREVARD, FL, 32901-3210
Project Congressional District FL-08
Number of Employees 3
NAICS code 621111
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Limited Liability Company(LLC)
Originating Lender ID 124402
Originating Lender Name Seacoast National Bank
Originating Lender Address Melbourne, FL
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 135076.93
Forgiveness Paid Date 2021-01-07
2116718308 2021-01-20 0455 PPS 1499 S Harbor City Blvd Ste 303, Melbourne, FL, 32901-3245
Loan Status Date 2021-11-11
Loan Status Paid in Full
Loan Maturity in Months 60
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 123799
Loan Approval Amount (current) 123799
Undisbursed Amount 0
Franchise Name -
Lender Location ID 17616
Servicing Lender Name Seacoast National Bank
Servicing Lender Address 815 Colorado Ave, STUART, FL, 34994-3053
Rural or Urban Indicator U
Hubzone Y
LMI Y
Business Age Description Existing or more than 2 years old
Project Address Melbourne, BREVARD, FL, 32901-3245
Project Congressional District FL-08
Number of Employees 10
NAICS code 621111
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Limited Liability Company(LLC)
Originating Lender ID 124402
Originating Lender Name Seacoast National Bank
Originating Lender Address Melbourne, FL
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 124689.67
Forgiveness Paid Date 2021-10-08

Date of last update: 01 Mar 2025

Sources: Florida Department of State