| Entity Name: | THSE-MARCO URGENT CARE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 09 Dec 2009 (15 years ago) |
| Document Number: | L09000117530 |
| FEI/EIN Number | 27-1463219 |
| Mail Address: | 265 BROOKVIEW CENTRE WAY, SUITE 203, KNOXVILLE, TN, 37919, US |
| Address: | 1643 NW 136TH AVE, BUILDING H, SUITE 100, Sunrise, FL, 33323, US |
| ZIP code: | 33323 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1801125331 | 2009-12-11 | 2020-09-29 | 1643 NW 136TH AVE STE 100, SUNRISE, FL, 333232857, US | 40 S HEATHWOOD DR, MARCO ISLAND, FL, 341455026, US | |||||||||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||||||||
| Phone | +1 800-424-3672 |
| Fax | 9543773042 |
| Phone | +1 239-394-8234 |
Authorized person
| Name | DR. MICHAEL D CORVINI |
| Role | PRESIDENT |
| Phone | 8004243672 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | Yes |
| Taxonomy Code | 363A00000X - Physician Assistant |
| Is Primary | No |
| Taxonomy Code | 363L00000X - Nurse Practitioner |
| Is Primary | No |
Other Provider Identifiers
| Issuer | BLUE CROSS FL |
| Number | 000JT |
| State | FL |
| Issuer | MEDICAID |
| Number | 002393100 |
| State | FL |
| Name | Role |
|---|---|
| CORPORATION SERVICE COMPANY | Agent |
| Name | Role | Address |
|---|---|---|
| Southwest Florida Emergency Management, LL | Manager | 1643 NW 136TH AVE, Sunrise, FL, 33323 |
| Name | Role | Address |
|---|---|---|
| STAIR JOHN | Assistant Secretary | 265 BROOKVIEW CENTRE WAY, SUITE 203, KNOXVILLE, TN, 37919 |
| Name | Role | Address |
|---|---|---|
| barrack john | Assistant Treasurer | 265 BROOKVIEW CENTRE WAY, SUITE 203, KNOXVILLE, TN, 37919 |
| Name | Role | Address |
|---|---|---|
| Corvini Michael | President | 265 BROOKVIEW CENTRE WAY, SUITE 203, KNOXVILLE, TN, 37919 |
| Name | Role | Address |
|---|---|---|
| Evans Rob | Vice President | 265 BROOKVIEW CENTRE WAY, SUITE 203, KNOXVILLE, TN, 37919 |
| Name | Role | Address |
|---|---|---|
| Leone Alice | Treasurer | 265 BROOKVIEW CENTRE WAY, SUITE 203, KNOXVILLE, TN, 37919 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2024-04-10 | 1643 NW 136TH AVE, BUILDING H, SUITE 100, Sunrise, FL 33323 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2022-04-12 | 1643 NW 136TH AVE, BUILDING H, SUITE 100, Sunrise, FL 33323 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-10 |
| ANNUAL REPORT | 2023-04-14 |
| ANNUAL REPORT | 2022-04-12 |
| ANNUAL REPORT | 2021-04-08 |
| ANNUAL REPORT | 2020-06-04 |
| ANNUAL REPORT | 2019-04-11 |
| ANNUAL REPORT | 2018-04-19 |
| ANNUAL REPORT | 2017-04-12 |
| ANNUAL REPORT | 2016-04-21 |
| ANNUAL REPORT | 2015-04-14 |
Date of last update: 01 Jan 2025
Sources: Florida Department of State
