| Entity Name: | OPTIMUM PRIMARY CARE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 13 Apr 2009 (16 years ago) |
| Date of dissolution: | 02 Jul 2019 (6 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 02 Jul 2019 (6 years ago) |
| Document Number: | L09000035198 |
| FEI/EIN Number | 264656240 |
| Address: | 1600 Marina Bay Dr, Panama City, FL, 32409, US |
| Mail Address: | P O BOX 16528, PANAMA CITY, FL, 32406 |
| ZIP code: | 32409 |
| County: | Bay |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1902049034 | 2009-04-20 | 2009-09-17 | PO BOX 16528, PANAMA CITY, FL, 324066528, US | 750 HARRISON AVE, PANAMA CITY, FL, 324012524, US | |||||||||||||||||||||||||||||
|
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| Phone | +1 850-215-4540 |
Authorized person
| Name | WAEL FARID |
| Role | PHYSICIAN |
| Phone | 2017579526 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | ME 99885 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS |
| Number | 29925 |
| State | FL |
| Issuer | MEDICAID |
| Number | 280906100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| FARID WAEL | Agent | 1600 Marina Bay Dr, Panama City, FL, 32409 |
| Name | Role | Address |
|---|---|---|
| FARID WAEL | President | P O BOX 16528, PANAMA CITY, FL, 32406 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2019-07-02 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2018-02-28 | 1600 Marina Bay Dr, 705, Panama City, FL 32409 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2018-02-28 | 1600 Marina Bay Dr, 705, Panama City, FL 32409 | No data |
| REINSTATEMENT | 2012-10-24 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2012-10-24 | 1600 Marina Bay Dr, 705, Panama City, FL 32409 | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2010-09-24 | No data | No data |
| Name | Date |
|---|---|
| VOLUNTARY DISSOLUTION | 2019-07-02 |
| ANNUAL REPORT | 2018-02-28 |
| ANNUAL REPORT | 2017-04-10 |
| ANNUAL REPORT | 2016-02-02 |
| ANNUAL REPORT | 2015-02-27 |
| ANNUAL REPORT | 2014-04-06 |
| ANNUAL REPORT | 2013-03-28 |
| REINSTATEMENT | 2012-10-24 |
| Florida Limited Liability | 2009-04-13 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
