| Entity Name: | MEDICAID PROVIDERS NETWORK, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 02 May 2012 (13 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: | L12000058969 |
| FEI/EIN Number | 45-5191674 |
| Address: | 3923-3927 Rosewood Way, ORLANDO, FL, 32808, US |
| Mail Address: | P.O. BOX 951659, LAKE MARY, FL, 32795-1659, US |
| ZIP code: | 32808 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1710325709 | 2013-06-12 | 2013-06-12 | PO BOX 951659, LAKE MARY, FL, 327951659, US | 2840 N HIAWASSEE RD, 428, ORLANDO, FL, 328183319, US | |||||||||||||||||||
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| Phone | +1 407-921-2074 |
| Fax | 4072648686 |
Authorized person
| Name | JASVENDAR SINGH NANDRA |
| Role | CEO |
| Phone | 4079212074 |
Taxonomy
| Taxonomy Code | 302F00000X - Exclusive Provider Organization |
| License Number | ME85696 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| Nandra Jasvendar SDr. | Agent | 3923-3927 Rosewood Way, ORLANDO, FL, 32808 |
| Name | Role | Address |
|---|---|---|
| NANDRA JASVENDAR S | Manager | 3923-3927 Rosewood Way, ORLANDO, FL, 32808 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2017-09-22 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2016-04-29 | 3923-3927 Rosewood Way, ORLANDO, FL 32808 | No data |
| REGISTERED AGENT NAME CHANGED | 2016-04-29 | Nandra, Jasvendar S, Dr. | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2016-04-29 | 3923-3927 Rosewood Way, ORLANDO, FL 32808 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2016-04-29 |
| ANNUAL REPORT | 2015-04-30 |
| ANNUAL REPORT | 2014-04-29 |
| ANNUAL REPORT | 2013-04-30 |
| Florida Limited Liability | 2012-05-02 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
