| Entity Name: | ADVANCE TAMPA BAY FOOT MEDICAL, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 18 Jun 2012 (13 years ago) |
| Document Number: | L12000080066 |
| FEI/EIN Number | 46-0622716 |
| Address: | In Care Of. Virtual only, 3917 Venetian way, TAMPA, FL 33634 |
| Mail Address: | P O BOX 13485, TAMPA, FL 33681-3485 |
| ZIP code: | 33634 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1821340225 | 2012-10-09 | 2017-05-11 | PO BOX 13485, TAMPA, FL, 336813485, US | 3325 W GANDY BLVD, TAMPA, FL, 336112931, US | |||||||||||||||||||||||
|
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| Phone | +1 813-831-3813 |
Authorized person
| Name | DR. BENJAMIN Q LE |
| Role | AUTHORIZE OFFICER |
| Phone | 8138313813 |
Taxonomy
| Taxonomy Code | 213ES0131X - Foot Surgery Podiatrist |
| License Number | PO2234 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 007286100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| LE, BENJAMIN Q, DPM | Agent | In Care Of. Virtual only, 3917 Venetian way, TAMPA, FL 33634 |
| Name | Role | Address |
|---|---|---|
| LE, BENJAMIN DPM | Managing Member | P O BOX 13485, TAMPA, FL 33681-3485 |
| LE, MARILYN DPM | Managing Member | P O BOX 13485, TAMPA, FL 33681-3485 |
| Le, Isaac Q | Managing Member | P O BOX 13485, TAMPA, FL 33681-3485 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-01-28 | In Care Of. Virtual only, 3917 Venetian way, TAMPA, FL 33634 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-01-28 | In Care Of. Virtual only, 3917 Venetian way, TAMPA, FL 33634 | No data |
| CHANGE OF MAILING ADDRESS | 2017-01-15 | In Care Of. Virtual only, 3917 Venetian way, TAMPA, FL 33634 | No data |
| REGISTERED AGENT NAME CHANGED | 2015-03-23 | LE, BENJAMIN Q, DPM | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-21 |
| ANNUAL REPORT | 2024-02-13 |
| ANNUAL REPORT | 2023-01-28 |
| ANNUAL REPORT | 2022-03-06 |
| ANNUAL REPORT | 2021-01-31 |
| ANNUAL REPORT | 2020-03-04 |
| ANNUAL REPORT | 2019-04-24 |
| ANNUAL REPORT | 2018-02-09 |
| ANNUAL REPORT | 2017-01-15 |
| ANNUAL REPORT | 2016-04-12 |
Date of last update: 22 Feb 2025
Sources: Florida Department of State
