| Entity Name: | LONG MEDICAL, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 14 Apr 2014 (11 years ago) |
| Date of dissolution: | 22 Feb 2017 (8 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 22 Feb 2017 (8 years ago) |
| Document Number: | L14000060673 |
| FEI/EIN Number | 465386283 |
| Address: | 140 BONAVENTURE BLVD, APT. 202, WESTON, FL, 33326, US |
| Mail Address: | 140 BONAVENTURE BLVD, APT. 202, WESTON, FL, 33326, US |
| ZIP code: | 33326 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1528472768 | 2014-06-16 | 2014-06-16 | 1172 FALLS BLVD, WESTON, FL, 333271722, US | 1172 FALLS BLVD, WESTON, FL, 333271722, US | |||||||||||||||||||||||||
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| Phone | +1 305-702-9441 |
| Fax | 3057029442 |
Authorized person
| Name | TANZEELA KHAN |
| Role | MD |
| Phone | 3057029441 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | ME 116720 |
| State | ZZ |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 009468100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| RODRIGUEZ ANNABELLA | Agent | 140 BONAVENTURE BLVD, WESTON, FL, 33326 |
| Name | Role | Address |
|---|---|---|
| LONG MATTHEW S | Manager | 6726 SW 152 PL, MIAMI, FL, 33193 |
| KHAN TANZEELA | Manager | 140 BONAVENTURE BLVD, APT 202, WESTON, FL, 33326 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2017-02-22 | No data | No data |
| LC AMENDMENT | 2014-09-15 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2014-09-15 | 140 BONAVENTURE BLVD, APT. 202, WESTON, FL 33326 | No data |
| CHANGE OF MAILING ADDRESS | 2014-09-15 | 140 BONAVENTURE BLVD, APT. 202, WESTON, FL 33326 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2014-09-15 | 140 BONAVENTURE BLVD, APT. 202, WESTON, FL 33326 | No data |
| LC AMENDMENT | 2014-05-05 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2016-05-01 |
| ANNUAL REPORT | 2015-04-23 |
| LC Amendment | 2014-09-15 |
| LC Amendment | 2014-05-05 |
| Florida Limited Liability | 2014-04-14 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
