| Entity Name: | MEDFLORIDA SPECIALISTS, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 14 Aug 2013 (11 years ago) |
| Last Event: | LC NAME CHANGE |
| Event Date Filed: | 19 Mar 2018 (7 years ago) |
| Document Number: | L13000114807 |
| FEI/EIN Number | 37-1816999 |
| Mail Address: | PO BOX 4189, Deerfield Beach, FL, 33442, US |
| Address: | 1950 W Hillsboro Blvd, Deerfield Beach, FL, 33442, US |
| ZIP code: | 33442 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1265105894 | 2021-07-29 | 2023-07-31 | PO BOX 4189, DEERFIELD BEACH, FL, 334424189, US | 4475 MEDICAL CENTER WAY, SUITE 3, WEST PALM BEACH, FL, 33407, US | |||||||||||||||||||||||||
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| Phone | +1 954-363-9595 |
| Fax | 9543639663 |
| Phone | +1 561-781-8070 |
| Fax | 5617818077 |
Authorized person
| Name | JORGE GIRALDO |
| Role | CREDENTIALING SPECIALIST |
| Phone | 9543639582 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 019754200 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Shikara Family Limited Liability Limited P | Agent | 1950 W Hillsboro Blvd, Deerfield Beach, FL, 33442 |
| Name | Role | Address |
|---|---|---|
| Shikara Family Limited Liability Limited P | Auth | 1950 W Hillsboro Blvd, Deerfield Beach, FL, 33442 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2022-01-21 | 1950 W Hillsboro Blvd, Ste 201, Deerfield Beach, FL 33442 | No data |
| CHANGE OF MAILING ADDRESS | 2022-01-21 | 1950 W Hillsboro Blvd, Ste 201, Deerfield Beach, FL 33442 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-01-21 | 1950 W Hillsboro Blvd, Ste 201, Deerfield Beach, FL 33442 | No data |
| LC NAME CHANGE | 2018-03-19 | MEDFLORIDA SPECIALISTS, LLC | No data |
| REGISTERED AGENT NAME CHANGED | 2017-04-23 | Shikara Family Limited Liability Limited Partnership | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-01 |
| ANNUAL REPORT | 2023-04-13 |
| ANNUAL REPORT | 2022-01-21 |
| ANNUAL REPORT | 2021-03-12 |
| ANNUAL REPORT | 2020-06-22 |
| ANNUAL REPORT | 2019-04-23 |
| ANNUAL REPORT | 2018-04-07 |
| LC Name Change | 2018-03-19 |
| ANNUAL REPORT | 2017-04-23 |
| ANNUAL REPORT | 2016-04-30 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
