| Entity Name: | LPS MEDICAL GROUP LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Inactive |
| Date Filed: | 29 Nov 2012 (12 years ago) |
| Date of dissolution: | 21 Jan 2015 (10 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 21 Jan 2015 (10 years ago) |
| Document Number: | L12000149288 |
| FEI/EIN Number | 46-1466720 |
| Address: | 1310 North Main Street, Ste. 105, Kissimmee, FL 34744 |
| Mail Address: | 1310 North Main Street, Ste. 105, Kissimmee, FL 34744 |
| ZIP code: | 34744 |
| County: | Osceola |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1003151903 | 2012-12-03 | 2013-12-06 | 1310 N MAIN ST STE 105, KISSIMMEE, FL, 347444244, US | 1310 N MAIN ST STE 105, KISSIMMEE, FL, 347444244, US | |||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 407-483-7975 |
| Fax | 8887725242 |
Authorized person
| Name | DR. CRUZ ADELMIS SANTOS |
| Role | PHYSICIAN |
| Phone | 4074764011 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | ME107498 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 007-666-400 |
| State | FL |
| Issuer | MEDICAID |
| Number | 004173700 |
| State | FL |
| Issuer | MEDICARE PTAN |
| Number | FP292Y |
| State | FL |
| Issuer | MEDICARE GROUP PTAN |
| Number | HI271A |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SANTOS, CRUZ A, MD | Agent | 2172 CONTINENTAL STREET, SAINT CLOUD, FL 34769 |
| Name | Role | Address |
|---|---|---|
| SANTOS, CRUZ A , MD | Managing Member | 2172 CONTINENTAL STREET, SAINT CLOUD, FL 34769 |
| LOPEZ-CESPEDES, JUAN A, MD | Managing Member | 1119 SUGARTREE DRIVE SOUTH, LAKELAND, FL 33813 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G12000114698 | LPS MEDICAL GROUP | EXPIRED | 2012-11-29 | 2017-12-31 | No data | 2172 CONTINENTAL STREET, SAINT CLOUD, FL, 34769 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2015-01-21 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2014-03-10 | 1310 North Main Street, Ste. 105, Kissimmee, FL 34744 | No data |
| CHANGE OF MAILING ADDRESS | 2014-03-10 | 1310 North Main Street, Ste. 105, Kissimmee, FL 34744 | No data |
| REGISTERED AGENT NAME CHANGED | 2013-01-26 | SANTOS, CRUZ A, MD | No data |
| Name | Date |
|---|---|
| VOLUNTARY DISSOLUTION | 2015-01-21 |
| ANNUAL REPORT | 2014-03-10 |
| ANNUAL REPORT | 2013-01-26 |
| Florida Limited Liability | 2012-11-29 |
Date of last update: 22 Feb 2025
Sources: Florida Department of State
