| Entity Name: | PERSONAL PEDIATRIC CARE, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Inactive |
| Date Filed: | 19 Nov 2010 (14 years ago) |
| Date of dissolution: | 22 Sep 2017 (7 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 22 Sep 2017 (7 years ago) |
| Document Number: | L10000120507 |
| FEI/EIN Number | 27-4025158 |
| Address: | 3012 STARKEY BLVD., TRINITY, FL 34655 |
| Mail Address: | 3012 STARKEY BLVD., TRINITY, FL 34655 |
| ZIP code: | 34655 |
| County: | Pasco |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1578860078 | 2011-02-17 | 2011-02-17 | 3012 STARKEY BLVD, TRINITY, FL, 346552175, US | 3012 STARKEY BLVD, TRINITY, FL, 346552175, US | |||||||||||||||||||||||||
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| Phone | +1 727-645-6941 |
| Fax | 7274947684 |
Authorized person
| Name | JAY MICHAEL HARVEY |
| Role | PHYSICIAN |
| Phone | 7276456941 |
Taxonomy
| Taxonomy Code | 208000000X - Pediatrics Physician |
| License Number | ME58972 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 054287300 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MCNAMARA, PATRICK J | Agent | 101 E. KENNEDY BLVD., SUITE 2000, TAMPA, FL 33602 |
| Name | Role | Address |
|---|---|---|
| HARVEY, JAY M | Managing Member | 3012 STARKEY BLVD., TRINITY, FL 34655 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2017-09-22 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2011-02-10 | 3012 STARKEY BLVD., TRINITY, FL 34655 | No data |
| CHANGE OF MAILING ADDRESS | 2011-02-10 | 3012 STARKEY BLVD., TRINITY, FL 34655 | No data |
| REGISTERED AGENT NAME CHANGED | 2011-02-10 | MCNAMARA, PATRICK J | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2011-02-10 | 101 E. KENNEDY BLVD., SUITE 2000, TAMPA, FL 33602 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2016-04-01 |
| ANNUAL REPORT | 2015-04-28 |
| ANNUAL REPORT | 2014-01-13 |
| ANNUAL REPORT | 2013-01-27 |
| ANNUAL REPORT | 2012-03-27 |
| ANNUAL REPORT | 2011-02-10 |
| Florida Limited Liability | 2010-11-19 |
Date of last update: 24 Jan 2025
Sources: Florida Department of State
