| Entity Name: | HIGH SPRINGS PEDIATRICS, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 26 Oct 2009 (15 years ago) |
| Last Event: | LC AMENDMENT AND NAME CHANGE |
| Event Date Filed: | 21 Jan 2010 (15 years ago) |
| Document Number: | L09000102851 |
| FEI/EIN Number | 271793975 |
| Address: | 19228 NW US HWY 441, HIGH SPRINGS, FL, 32643, US |
| Mail Address: | 19228 NW US HWY 441, HIGH SPRINGS, FL, 32643, US |
| ZIP code: | 32643 |
| County: | Alachua |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1891171914 | 2015-07-31 | 2015-08-11 | 14900 NW 140TH ST, ALACHUA, FL, 326156276, US | 14900 NW 140TH ST, ALACHUA, FL, 326156276, US | |||||||||||||||||||||||||
|
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| Phone | +1 386-418-0004 |
| Fax | 3864180033 |
Authorized person
| Name | DR. NASIR UDDIN AHMED |
| Role | MEDICAL DOCTOR |
| Phone | 3864541156 |
Taxonomy
| Taxonomy Code | 261QR1300X - Rural Health Clinic/Center |
| License Number | ME97945 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 277630800 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| AHMED NASIR U | Agent | 19228 NW US HWY 441, HIGH SPRING, FL, 32643 |
| Name | Role | Address |
|---|---|---|
| AHMED NASIR U | Managing Member | 19228 NW US HWY 441, HIGH SPRINGS, FL, 32643 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2017-03-15 | 19228 NW US HWY 441, HIGH SPRINGS, FL 32643 | No data |
| CHANGE OF MAILING ADDRESS | 2017-03-15 | 19228 NW US HWY 441, HIGH SPRINGS, FL 32643 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2017-03-15 | 19228 NW US HWY 441, HIGH SPRING, FL 32643 | No data |
| LC AMENDMENT AND NAME CHANGE | 2010-01-21 | HIGH SPRINGS PEDIATRICS, LLC | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-23 |
| ANNUAL REPORT | 2023-04-24 |
| ANNUAL REPORT | 2022-04-26 |
| ANNUAL REPORT | 2021-05-01 |
| ANNUAL REPORT | 2020-04-25 |
| ANNUAL REPORT | 2019-04-26 |
| ANNUAL REPORT | 2018-04-30 |
| ANNUAL REPORT | 2017-03-15 |
| ANNUAL REPORT | 2016-03-17 |
| ANNUAL REPORT | 2015-01-30 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
