| Entity Name: | MESA MEDICAL, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 13 Feb 2013 (12 years ago) |
| Date of dissolution: | 22 Sep 2023 (a year ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 22 Sep 2023 (a year ago) |
| Document Number: | L13000023206 |
| FEI/EIN Number | 300764591 |
| Address: | 1860 FOREST HILL BOULEVARD, SUITE 102, WEST PALM BEACH, FL, 33406, US |
| Mail Address: | 1860 FOREST HILL BOULEVARD, SUITE 1021, WEST PALM BEACH, FL, 33406, US |
| ZIP code: | 33406 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1477967511 | 2014-06-17 | 2014-06-17 | 1870 FOREST HILL BLVD, STE 101, WEST PALM BEACH, FL, 334066057, US | 1870 FOREST HILL BLVD, WEST PALM BEACH, FL, 334066057, US | |||||||||||||||||||||||||
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| Phone | +1 561-766-2373 |
| Fax | 5617662615 |
Authorized person
| Name | DR. ANGEL R MESA |
| Role | DOCTOR |
| Phone | 5617662373 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | ME99661 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 279227300 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MESA UENDI E | Agent | 1860 FOREST HILL BOULEVARD, WEST PALM BEACH, FL, 33406 |
| Name | Role | Address |
|---|---|---|
| MESA UENDI | Managing Member | 1860 FOREST HILL BOULEVARD, WEST PALM BEACH, FL, 33406 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G18000106216 | ANGEL R MESA, MD | EXPIRED | 2018-09-27 | 2023-12-31 | No data | 1860 FOREST HILL BLVD SUITE, 102, WEST PALM BEACH, FL, 33406 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2023-09-22 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2019-04-18 | MESA, UENDI ELISABEL | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2016-03-03 | 1860 FOREST HILL BOULEVARD, SUITE 102, WEST PALM BEACH, FL 33406 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2015-03-27 | 1860 FOREST HILL BOULEVARD, SUITE 102, WEST PALM BEACH, FL 33406 | No data |
| CHANGE OF MAILING ADDRESS | 2015-03-27 | 1860 FOREST HILL BOULEVARD, SUITE 102, WEST PALM BEACH, FL 33406 | No data |
| REINSTATEMENT | 2014-10-31 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2014-09-26 | No data | No data |
| LC AMENDMENT | 2013-04-01 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2022-02-25 |
| ANNUAL REPORT | 2021-02-04 |
| ANNUAL REPORT | 2020-02-17 |
| ANNUAL REPORT | 2019-04-18 |
| ANNUAL REPORT | 2018-04-02 |
| ANNUAL REPORT | 2017-03-10 |
| ANNUAL REPORT | 2016-03-03 |
| ANNUAL REPORT | 2015-03-27 |
| REINSTATEMENT | 2014-10-31 |
| LC Amendment | 2013-04-01 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
