| Entity Name: | MID-FLORIDA EMERGENCY PHYSICIANS, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 23 Dec 2011 (13 years ago) |
| Document Number: | L11000143728 |
| FEI/EIN Number | 45-4112092 |
| Address: | 200 CORPORATE BLVD., LAFAYETTE, LA 70508 |
| Mail Address: | ATTN: ENTITY MANAGEMENT, 200 Corporate Blvd, Lafayette, LA 70508 |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1558630152 | 2011-12-28 | 2022-03-23 | 200 CORPORATE BLVD, LAFAYETTE, LA, 705083870, US | 3600 S HIGHLANDS AVE, SEBRING, FL, 338705416, US | |||||||||||||||||||||||||||||
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| Phone | +1 800-893-9698 |
| Phone | +1 877-693-5700 |
Authorized person
| Name | LISHA C FALK |
| Role | VP OF CONTRACTING |
| Phone | 3376091221 |
Taxonomy
| Taxonomy Code | 207P00000X - Emergency 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 | MEDICAID |
| Number | 004547001 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CT CORPORATION SYSTEM | Agent | 1200 SOUTH PINE ISLAND ROAD, PLANTATION, FL 33324 |
| Name | Role |
|---|---|
| EDCARE MANAGEMENT, INC. | Managing Member |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2016-04-05 | 200 CORPORATE BLVD., LAFAYETTE, LA 70508 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2016-01-26 | 200 CORPORATE BLVD., LAFAYETTE, LA 70508 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-10 |
| ANNUAL REPORT | 2023-02-09 |
| ANNUAL REPORT | 2022-03-17 |
| ANNUAL REPORT | 2021-01-29 |
| ANNUAL REPORT | 2020-02-07 |
| ANNUAL REPORT | 2019-04-12 |
| ANNUAL REPORT | 2018-03-06 |
| ANNUAL REPORT | 2017-03-23 |
| ANNUAL REPORT | 2016-04-05 |
| ANNUAL REPORT | 2015-04-23 |
Date of last update: 23 Jan 2025
Sources: Florida Department of State
