| 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. |
| 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 |
| 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 | |||||||||||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||||||||||
| 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 |
| 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 |
| 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 |
| 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 | - |
| 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 |
| 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 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 2116718308 | 2021-01-20 | 0455 | PPS | 1499 S Harbor City Blvd Ste 303, Melbourne, FL, 32901-3245 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Date of last update: 01 Mar 2025
Sources: Florida Department of State
