| Entity Name: | BEGUM INTERNAL MEDICINE LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 10 Apr 2013 (12 years ago) |
| Document Number: | L13000052779 |
| FEI/EIN Number | 46-2499499 |
| Address: | 1283 SW STATE ROAD 47, 101, LAKE CITY, FL, 32025 |
| Mail Address: | 397 SW Highpoint Gln, Lake City, FL, 32024, US |
| ZIP code: | 32025 |
| County: | Columbia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1023453222 | 2013-05-02 | 2021-02-15 | 1283 SW STATE ROAD 47, SUITE 101, LAKE CITY, FL, 320250489, US | 1283 SW STATE ROAD 47, SUITE 101, LAKE CITY, FL, 320250489, US | |||||||||||||||||||||||||
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| Phone | +1 386-438-5255 |
| Fax | 3864385618 |
Authorized person
| Name | DR. TOHMINA BEGUM |
| Role | OWNER |
| Phone | 2036953966 |
Taxonomy
| Taxonomy Code | 173000000X - Legal Medicine |
| License Number | ME109244 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 107531200 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Begum Tohmina | Agent | 1283 SW STATE ROAD 47, LAKE CITY, FL, 32025 |
| Name | Role | Address |
|---|---|---|
| HUDA NURUL | Manager | 1283 SW STATE ROAD 47, LAKE CITY, FL, 32025 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2023-01-16 | Begum, Tohmina | No data |
| CHANGE OF MAILING ADDRESS | 2017-04-06 | 1283 SW STATE ROAD 47, 101, LAKE CITY, FL 32025 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-20 |
| ANNUAL REPORT | 2024-03-07 |
| ANNUAL REPORT | 2023-01-16 |
| ANNUAL REPORT | 2022-02-15 |
| ANNUAL REPORT | 2021-04-13 |
| ANNUAL REPORT | 2020-05-12 |
| ANNUAL REPORT | 2019-04-24 |
| ANNUAL REPORT | 2018-03-11 |
| ANNUAL REPORT | 2017-04-06 |
| ANNUAL REPORT | 2016-03-25 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
