| Entity Name: | EAST FLORIDA PREMIUM MEDICAL CARE L.L.C. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 23 Jan 2012 (13 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 28 Nov 2016 (8 years ago) |
| Document Number: | L12000010351 |
| FEI/EIN Number | 364723473 |
| Address: | 7421 NORTH UNIVERSITY DRIVE, SUITE 301, TAMARAC, FL, 33321, US |
| Mail Address: | 7421 NORTH UNIVERSITY DRIVE, SUITE 301, TAMARAC, FL, 33321, US |
| ZIP code: | 33321 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1326312125 | 2012-02-27 | 2022-11-18 | 7421 N. UNIVERSITY DRIVE, STE 314, TAMARAC, FL, 33321, US | 7421 N. UNIVERSITY DRIVE, STE 314, TAMARAC, FL, 33321, US | |||||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 954-724-3440 |
| Fax | 9547243494 |
Authorized person
| Name | DR. ERROL EARL CAMPBELL |
| Role | MEDICAL DIRECTOR |
| Phone | 9547243440 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | ME80593 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 208D00000X - General Practice Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 109864400 |
| State | FL |
| Issuer | MEDICAID |
| Number | 000758100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| NOEL JEAN HEROLD | Agent | 7421 NORTH UNIVERSITY DRIVE, TAMARAC, FL, 33321 |
| Name | Role | Address |
|---|---|---|
| NOEL JEAN HEROLD | Manager | 1363 SW 161 AVE, PEMBROKE PINES, FL, 33027 |
| ANDRE VALENTIN Dr. | Manager | 1995 NW 162ND AVE, PEMBROKE PINES, FL, 33028 |
| MONROSE ANEL | Manager | 8855 PARKLAND BAY DRIVE, PARKLAND, FL, 33076 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G20000066851 | EAST FLORIDA MED CARE | ACTIVE | 2020-06-14 | 2025-12-31 | No data | 7421 NORTH UNIVERSITY DR, SUITE 314, TAMARAC, FL, 33321 |
| G20000066858 | EAST FLORIDA MEDCARE | ACTIVE | 2020-06-14 | 2025-12-31 | No data | 7421 NORTH UNIVERSITY DRIVE, SUITE 314, TAMARAC, FL, 33321 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2022-01-10 | 7421 NORTH UNIVERSITY DRIVE, SUITE 301, TAMARAC, FL 33321 | No data |
| CHANGE OF MAILING ADDRESS | 2022-01-10 | 7421 NORTH UNIVERSITY DRIVE, SUITE 301, TAMARAC, FL 33321 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-01-10 | 7421 NORTH UNIVERSITY DRIVE, SUITE 301, TAMARAC, FL 33321 | No data |
| REGISTERED AGENT NAME CHANGED | 2019-01-18 | NOEL, JEAN HEROLD | No data |
| REINSTATEMENT | 2016-11-28 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2016-09-23 | No data | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J17000256240 | TERMINATED | 1000000742007 | BROWARD | 2017-04-28 | 2027-05-05 | $ 959.87 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, CORAL SPRINGS SERVICE CENTER, 3301 N UNIVERSITY DR STE 200, CORAL SPRINGS FL330654149 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-25 |
| ANNUAL REPORT | 2023-03-11 |
| ANNUAL REPORT | 2022-01-10 |
| ANNUAL REPORT | 2021-02-01 |
| ANNUAL REPORT | 2020-01-07 |
| ANNUAL REPORT | 2019-01-18 |
| ANNUAL REPORT | 2018-08-27 |
| ANNUAL REPORT | 2017-04-21 |
| REINSTATEMENT | 2016-11-28 |
| ANNUAL REPORT | 2015-03-19 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
