| Entity Name: | PREMIUM HEALTH SERVICES OF TAMPA LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Florida Limited Liability Co.
PREMIUM HEALTH SERVICES OF TAMPA 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: | 22 Jul 2009 (16 years ago) |
| Document Number: | L09000070527 |
| FEI/EIN Number |
270770864
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Mail Address: | 13318 Walden Sheffield Rd, Dover, FL, 33527, US |
| Address: | 4018 Highview Rd, Seffner, FL, 33584, US |
| ZIP code: | 33584 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1790060366 | 2011-10-14 | 2011-10-14 | 6015 REX HALL LN, APOLLO BEACH, FL, 335722657, US | 107 W ROBERTSON ST, BRANDON, FL, 335115111, US | |||||||||||||||||||||||||||||||
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| Phone | +1 813-690-7589 |
| Phone | +1 813-651-4100 |
| Fax | 8136514111 |
Authorized person
| Name | DR. KHAWAJA A RAHMAN |
| Role | PRESIDENT |
| Phone | 8136514100 |
Taxonomy
| Taxonomy Code | 261QU0200X - Urgent Care Clinic/Center |
| License Number | ME79013 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICARE INDIVIDUAL |
| Number | 49283V |
| Issuer | MEDICAL LICENSE |
| Number | ME79013 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| RAHMAN KHAWAJA A | Manager | 13318 WALDEN SHEFFIELD RD, DOVER, FL, 33527 |
| RAHMAN SAMIA | Manager | 13318 WALDEN SHEFFIELD RD, DOVER, FL, 33527 |
| RAHMAN KHAWAJA A | Agent | 13318 WALDEN SHEFFIELD RD, DOVER, FL, 33527 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2020-03-07 | 4018 Highview Rd, Seffner, FL 33584 | - |
| CHANGE OF MAILING ADDRESS | 2013-04-03 | 4018 Highview Rd, Seffner, FL 33584 | - |
| REGISTERED AGENT ADDRESS CHANGED | 2013-04-03 | 13318 WALDEN SHEFFIELD RD, DOVER, FL 33527 | - |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-30 |
| ANNUAL REPORT | 2023-04-13 |
| ANNUAL REPORT | 2022-03-11 |
| ANNUAL REPORT | 2021-04-13 |
| ANNUAL REPORT | 2020-03-07 |
| ANNUAL REPORT | 2019-04-04 |
| ANNUAL REPORT | 2018-04-29 |
| ANNUAL REPORT | 2017-04-04 |
| ANNUAL REPORT | 2016-03-01 |
| ANNUAL REPORT | 2015-02-22 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 5200747709 | 2020-05-01 | 0455 | PPP | 4018 HIGHVIEW RD, SEFFNER, FL, 33584-5202 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 02 Mar 2025
Sources: Florida Department of State
