| Entity Name: | LAKE WALES EMERGENCY PHYSICIANS, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Florida Limited Liability Co.
LAKE WALES EMERGENCY PHYSICIANS, LLC is structured as a Limited Liability Company (LLC), a common business structure that offers its members limited liability protection, separating their personal assets from the company's debts and obligations. |
| Status: |
Active
The business entity is active. This status indicates that the business is currently operating and compliant with state regulations, suggesting a lower risk profile for lenders and potentially better creditworthiness. |
| Date Filed: | 12 Jan 2012 (13 years ago) |
| Document Number: | L12000006095 |
| FEI/EIN Number |
45-4250237
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 200 CORPORATE BLVD, LAFAYETTE, LA, 70508, US |
| Mail Address: | 200 Corporate Blvd, Lafayette, LA, 70508, US |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1033480405 | 2012-01-18 | 2022-03-23 | 200 CORPORATE BLVD, LAFAYETTE, LA, 705083870, US | 410 S 11TH ST, LAKE WALES, FL, 338534203, US | |||||||||||||||||||||||||||||
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| Phone | +1 800-893-9698 |
| Phone | +1 877-693-5700 |
Authorized person
| Name | LISHA C FALK |
| Role | PRESIDENT |
| 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 | 004700800 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| EDCARE MANAGEMENT, INC. | Manager | - |
| CT CORPORATION SYSTEM | Agent | 1200 SOUTH PINE ISLAND ROAD, PLANTATION, FL, 33324 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-03-07 | 200 CORPORATE BLVD, LAFAYETTE, LA 70508 | - |
| CHANGE OF MAILING ADDRESS | 2023-03-07 | 200 CORPORATE BLVD, LAFAYETTE, LA 70508 | - |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-08 |
| ANNUAL REPORT | 2023-03-07 |
| ANNUAL REPORT | 2022-03-17 |
| ANNUAL REPORT | 2021-02-05 |
| ANNUAL REPORT | 2020-02-07 |
| ANNUAL REPORT | 2019-04-12 |
| ANNUAL REPORT | 2018-03-06 |
| ANNUAL REPORT | 2017-03-22 |
| ANNUAL REPORT | 2016-04-05 |
| ANNUAL REPORT | 2015-04-23 |
Date of last update: 02 Mar 2025
Sources: Florida Department of State
