| Entity Name: | KOPA, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 20 Feb 2014 (11 years ago) |
| Last Event: | LC STMNT OF RA/RO CHG |
| Event Date Filed: | 27 Dec 2021 (3 years ago) |
| Document Number: | L14000030951 |
| FEI/EIN Number | 20-1457851 |
| Address: | 5900 LAKE ELLENOR DR., 700C, ORLANDO, FL 32809 |
| Mail Address: | 5900 LAKE ELLENOR DR., 700C, ORLANDO, FL 32809 |
| ZIP code: | 32809 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1417021114 | 2006-11-17 | 2023-12-22 | 5900 LAKE ELLENOR DR STE 700, ORLANDO, FL, 328094643, US | 5900 LAKE ELLENOR DR STE 700, ORLANDO, FL, 328094643, US | |||||||||||||||||||||||||||||||||||||
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| Phone | +1 407-352-2542 |
| Fax | 8445568650 |
Authorized person
| Name | KIMBERLY L BIEGASIEWICZ |
| Role | PRESIDENT |
| Phone | 4072160101 |
Taxonomy
| Taxonomy Code | 208M00000X - Hospitalist Physician |
| Is Primary | No |
| Taxonomy Code | 261QM1300X - Multi-Specialty Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | AHCA |
| Number | HCC10648 |
| State | FL |
| Issuer | MEDICAID |
| Number | 107434200 |
| State | FL |
| Issuer | BLUE CROSS BLUE SHEILD |
| Number | 94707 |
| State | FL |
| Name | Role |
|---|---|
| CORPORATION SERVICE COMPANY | Agent |
| Name | Role | Address |
|---|---|---|
| BIEGASIEWICZ, KIMBERLY L. | Director | 5900 LAKE ELLENOR DR., 700C ORLANDO, FL 32809 |
| Name | Role | Address |
|---|---|---|
| BIEGASIEWICZ, KIMBERLY L. | President | 5900 LAKE ELLENOR DR., 700C ORLANDO, FL 32809 |
| Name | Role |
|---|---|
| GF HEALTH LLC | Manager |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G23000001338 | AVANTE PHYSICIAN SERVICES | ACTIVE | 2023-01-04 | 2028-12-31 | No data | 5900 LAKE ELLENOR DRIVE, SUITE 700A, ORLANDO, FL, 32809 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC STMNT OF RA/RO CHG | 2021-12-27 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-12-27 | 1201 HAYS STREET, TALLAHASSEE, FL 32301-2525 | No data |
| REGISTERED AGENT NAME CHANGED | 2021-12-27 | CORPORATION SERVICE COMPANY | No data |
| CHANGE OF MAILING ADDRESS | 2021-01-31 | 5900 LAKE ELLENOR DR., 700C, ORLANDO, FL 32809 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2021-01-31 | 5900 LAKE ELLENOR DR., 700C, ORLANDO, FL 32809 | No data |
| REINSTATEMENT | 2019-11-15 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2019-09-27 | No data | No data |
| REINSTATEMENT | 2015-10-16 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2015-09-25 | No data | No data |
| LC STMNT CORR | 2014-03-20 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-14 |
| ANNUAL REPORT | 2023-02-22 |
| ANNUAL REPORT | 2022-03-19 |
| CORLCRACHG | 2021-12-27 |
| ANNUAL REPORT | 2021-01-31 |
| ANNUAL REPORT | 2020-06-25 |
| REINSTATEMENT | 2019-11-15 |
| ANNUAL REPORT | 2018-03-28 |
| ANNUAL REPORT | 2017-01-10 |
| ANNUAL REPORT | 2016-04-18 |
Date of last update: 22 Jan 2025
Sources: Florida Department of State
