| Entity Name: | PREMIER FAMILY AND SPORTS MEDICINE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 28 Jun 2012 (13 years ago) |
| Document Number: | L12000085273 |
| FEI/EIN Number | 460543784 |
| Address: | 2940 MAGUIRE ROAD, OCOEE, FL, 34761, US |
| Mail Address: | 2940 MAGUIRE ROAD, OCOEE, FL, 34761, US |
| ZIP code: | 34761 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1184970626 | 2012-08-02 | 2019-03-27 | 2940 MAGUIRE RD STE 200, OCOEE, FL, 347614751, US | 2940 MAGUIRE RD STE 200, OCOEE, FL, 347614751, US | |||||||||||||||||||||||||||||||||||||||
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| Phone | +1 407-581-9065 |
| Fax | 3213485827 |
Authorized person
| Name | DR. ADAM LANGLEY |
| Role | CO-OWNER/PHYSICIAN |
| Phone | 4075819065 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | ME105078 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 207QS0010X - Sports Medicine (Family Medicine) Physician |
| License Number | ME105459 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 004227500 |
| State | FL |
| Issuer | MEDICAID |
| Number | 004046500 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Visser Gary | Agent | 2940 MAGUIRE ROAD, OCOEE, FL, 34761 |
| Name | Role | Address |
|---|---|---|
| VISSER GARY C | Manager | 2940 MAGUIRE ROAD, OCOEE, FL, 34761 |
| LANGLEY ADAM W | Manager | 2940 MAGUIRE ROAD, OCOEE, FL, 34761 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G12000093670 | PREMIERMED | EXPIRED | 2012-09-24 | 2017-12-31 | No data | 2658 MAGUIRE ROAD, OCOEE, FL, 34761 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2022-02-24 | Visser, Gary | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2018-02-13 | 2940 MAGUIRE ROAD, SUITE 200, OCOEE, FL 34761 | No data |
| CHANGE OF MAILING ADDRESS | 2018-02-13 | 2940 MAGUIRE ROAD, SUITE 200, OCOEE, FL 34761 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2018-02-13 | 2940 MAGUIRE ROAD, SUITE 200, OCOEE, FL 34761 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-04 |
| ANNUAL REPORT | 2023-02-14 |
| ANNUAL REPORT | 2022-02-24 |
| ANNUAL REPORT | 2021-01-29 |
| ANNUAL REPORT | 2020-01-23 |
| ANNUAL REPORT | 2019-04-03 |
| ANNUAL REPORT | 2018-02-13 |
| ANNUAL REPORT | 2017-03-15 |
| ANNUAL REPORT | 2016-03-30 |
| ANNUAL REPORT | 2015-01-08 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
