| Entity Name: | SUPREME MEDICAL GROUP PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 25 May 2012 (13 years ago) |
| Document Number: | L12000070821 |
| FEI/EIN Number | 45-5361082 |
| Address: | 10967 lake under hill rd, ORLANDO, FL, 32825-4455, US |
| Mail Address: | 10967 lake under hill rd, ORLANDO, FL, 32825-4455, US |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1073970810 | 2016-01-25 | 2020-12-23 | 10967 LAKE UNDER HILL ROAD, UNIT 137, ORLANDO, FL, 328254455, US | 10967 LAKE UNDER HILL RD, UNIT 137, ORLANDO, FL, 328254455, US | |||||||||||||||||||
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| Phone | +1 407-930-1030 |
| Fax | 4073867277 |
Authorized person
| Name | DR. SHEENA MARY JOSE |
| Role | MEDICAL DIRECTOR |
| Phone | 4079301030 |
Taxonomy
| Taxonomy Code | 207RI0200X - Infectious Disease Physician |
| License Number | ME109765 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| JOSE SHEENA M | Agent | 1945 MITCHELL BROOK LANE, CASSELBERRY, FL, 32707 |
| Name | Role | Address |
|---|---|---|
| JOSE SHEENA M | Managing Member | 10822 LAGO BELLA DRIVE, ORLANDO, FL, 32832 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2019-09-19 | 10967 lake under hill rd, ste 137, ORLANDO, FL 32825-4455 | No data |
| CHANGE OF MAILING ADDRESS | 2019-09-19 | 10967 lake under hill rd, ste 137, ORLANDO, FL 32825-4455 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-08 |
| ANNUAL REPORT | 2023-02-22 |
| ANNUAL REPORT | 2022-03-02 |
| ANNUAL REPORT | 2021-04-17 |
| ANNUAL REPORT | 2020-06-10 |
| ANNUAL REPORT | 2019-04-10 |
| ANNUAL REPORT | 2018-04-14 |
| ANNUAL REPORT | 2017-04-21 |
| ANNUAL REPORT | 2016-04-24 |
| ANNUAL REPORT | 2015-04-25 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
