| Entity Name: | PREMIUM PRACTICE SOLUTIONS, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 17 Mar 2011 (14 years ago) |
| Last Event: | LC NAME CHANGE |
| Event Date Filed: | 07 Dec 2015 (9 years ago) |
| Document Number: | L11000032725 |
| FEI/EIN Number | 451152247 |
| Address: | 5340 N FEDERAL HWY, SUITE 110, LIGHTHOUSE POINT, FL, 33064, US |
| Mail Address: | 5340 N FEDERAL HWY, SUITE 110, LIGHTHOUSE POINT, FL, 33064, US |
| ZIP code: | 33064 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1164711214 | 2011-03-29 | 2021-10-25 | 5340 N FEDERAL HWY STE 110, LIGHTHOUSE POINT, FL, 330647058, US | 5340 N FEDERAL HWY STE 110, LIGHTHOUSE POINT, FL, 330647058, US | |||||||||||||||||||||||||||||||
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| Phone | +1 954-428-2480 |
| Fax | 9544282904 |
Authorized person
| Name | HANG NGUYEN |
| Role | OFFICE MANAGER |
| Phone | 9544282480 |
Taxonomy
| Taxonomy Code | 207RG0100X - Gastroenterology Physician |
| License Number | ME89279 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 008600100 |
| State | FL |
| Issuer | MEDICARE |
| Number | FG672A |
| State | FL |
| Name | Role | Address |
|---|---|---|
| GUPTA VIPIN | Agent | 5340 N FEDERAL HWY, SUITE 110, LIGHTHOUSE POINT, FL, 33064 |
| Name | Role | Address |
|---|---|---|
| GUPTA VIPIN K | Managing Member | 5340 N FEDERAL HWY, SUITE 110, LIGHTHOUSE POINT, FL, 33064 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G16000005525 | INTERNAL MEDICINE ASSOCIATES | EXPIRED | 2016-01-14 | 2021-12-31 | No data | 1500 E HILLSBORO BLVD, SUITE 207, DEERFIELD BEACH, FL, 33441 |
| G15000125357 | SPECIALTY GASTRO CENTER | EXPIRED | 2015-12-11 | 2020-12-31 | No data | 1500 EAST HILLSBORO BLVD, DEERFIELD BEACH, FL, 33441 |
| G15000125359 | SPECIALTY PAIN CENTER | EXPIRED | 2015-12-11 | 2020-12-31 | No data | 1500 EAST HILLSBORO BLVD, DEERFIELD BEACH, FL, 33441 |
| G15000091215 | INTERNAL MEDICINE ASSOCIATES | EXPIRED | 2015-09-03 | 2020-12-31 | No data | 1500 EAST HILLSBORO BLVD, SUITE 207, DEERFIELD BEACH, FL, 33441 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2018-04-17 | 5340 N FEDERAL HWY, SUITE 110, LIGHTHOUSE POINT, FL 33064 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2017-09-13 | 5340 N FEDERAL HWY, SUITE 110, LIGHTHOUSE POINT, FL 33064 | No data |
| CHANGE OF MAILING ADDRESS | 2017-09-13 | 5340 N FEDERAL HWY, SUITE 110, LIGHTHOUSE POINT, FL 33064 | No data |
| LC NAME CHANGE | 2015-12-07 | PREMIUM PRACTICE SOLUTIONS, LLC | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-16 |
| ANNUAL REPORT | 2023-04-28 |
| ANNUAL REPORT | 2022-04-29 |
| ANNUAL REPORT | 2021-04-05 |
| ANNUAL REPORT | 2020-06-24 |
| ANNUAL REPORT | 2019-04-26 |
| ANNUAL REPORT | 2018-04-17 |
| ANNUAL REPORT | 2017-04-28 |
| ANNUAL REPORT | 2016-03-09 |
| LC Name Change | 2015-12-07 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
