| Entity Name: | MEDICARE PROVIDERS NETWORK, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Inactive |
| Date Filed: | 29 Jan 2013 (12 years ago) |
| Date of dissolution: | 25 Sep 2015 (9 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 25 Sep 2015 (9 years ago) |
| Document Number: | L13000014377 |
| FEI/EIN Number | 46-1910227 |
| Address: | 2840 NORTH HIAWASSEE ROAD, ORLANDO, FL 32818 |
| Mail Address: | P.O. BOX 951659, LAKE MARY, FL 32795 |
| ZIP code: | 32818 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1205275401 | 2013-06-20 | 2013-06-20 | PO BOX 951659, LAKE MARY, FL, 327951659, US | 2840 N HIAWASSEE RD, STE # 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 |
|---|---|---|
| FLICK, JAMES J | Agent | 3700 S. CONWAY ROAD, 100, ORLANDO, FL 32812 |
| Name | Role | Address |
|---|---|---|
| NANDRA, JASVENDER | Manager | 2840 NORTH HIAWASSEE ROAD, ORLANDO, FL 32818 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2015-09-25 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2014-04-30 |
| Florida Limited Liability | 2013-01-29 |
Date of last update: 23 Jan 2025
Sources: Florida Department of State
