| Entity Name: | EXCELLENCE MEDICAL CENTERS, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 01 Jun 2010 (15 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 28 Feb 2012 (13 years ago) |
| Document Number: | L10000058154 |
| FEI/EIN Number | 272731289 |
| Address: | 4304 DEL PRADO BLVD S, CAPE CORAL, FL, 33904, US |
| Mail Address: | 4304 DEL PRADO BLVD S, CAPE CORAL, FL, 33904, US |
| ZIP code: | 33904 |
| County: | Lee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1629388319 | 2010-10-14 | 2020-08-07 | 4304 DEL PRADO BLVD S, CAPE CORAL, FL, 339047169, US | 4304 DEL PRADO BLVD S, CAPE CORAL, FL, 339047169, US | |||||||||||||||||||||||||||||||
|
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| Phone | +1 239-540-0800 |
| Fax | 2395400806 |
Authorized person
| Name | CHRISTINE MACKIE |
| Role | OWNER |
| Phone | 2395400800 |
Taxonomy
| Taxonomy Code | 208D00000X - General Practice Physician |
| License Number | ME94225 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 273771000 |
| State | FL |
| Issuer | BC BS |
| Number | 29322 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MACKIE CHRISTINE M | Agent | 4304 DEL PRADO BLVD S, CAPE CORAL, FL, 33904 |
| Name | Role | Address |
|---|---|---|
| MACKIE CHRISTINE M | Managing Member | 4304 DEL PRADO BLVD S, CAPE CORAL, FL, 33904 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2014-04-24 | 4304 DEL PRADO BLVD S, CAPE CORAL, FL 33904 | No data |
| CHANGE OF MAILING ADDRESS | 2014-04-24 | 4304 DEL PRADO BLVD S, CAPE CORAL, FL 33904 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2014-04-24 | 4304 DEL PRADO BLVD S, CAPE CORAL, FL 33904 | No data |
| REINSTATEMENT | 2012-02-28 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2011-09-23 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-25 |
| ANNUAL REPORT | 2023-04-28 |
| ANNUAL REPORT | 2022-04-28 |
| ANNUAL REPORT | 2021-04-30 |
| ANNUAL REPORT | 2020-06-23 |
| ANNUAL REPORT | 2019-04-30 |
| ANNUAL REPORT | 2018-04-25 |
| ANNUAL REPORT | 2017-04-27 |
| ANNUAL REPORT | 2016-04-29 |
| ANNUAL REPORT | 2015-04-27 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
