| Entity Name: | PHYSICIANS CARE CLINIC, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 16 Jun 2014 (11 years ago) |
| Document Number: | L14000096348 |
| FEI/EIN Number | 47-1123495 |
| Address: | 4100 S. HOSPITAL DRIVE, SUITE 111, FORT LAUDERDALE, FL, 33317 |
| Mail Address: | 6976 SPYGLASS AVENUE, PARKLAND, FL, 33076 |
| ZIP code: | 33317 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1003225475 | 2014-08-10 | 2014-08-10 | 4100 S HOSPITAL DR, SUITE #111, PLANTATION, FL, 333172813, US | 4100 S HOSPITAL DR, SUITE #111, PLANTATION, FL, 333172813, US | |||||||||||||||||||||
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| Phone | +1 954-585-1996 |
| Fax | 9547851998 |
Authorized person
| Name | GEORGE ELIAS ROVITO |
| Role | DOCTOR |
| Phone | 9545851996 |
Taxonomy
| Taxonomy Code | 261QM1300X - Multi-Specialty Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | LICENSE |
| Number | ME30354 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SMITH AEBEL ERIN ESQ. | Agent | SHUMAKER, LOOP & KENDRICK, LLP, TAMPA, FL, 33602 |
| Name | Role | Address |
|---|---|---|
| BALTAZAR SHELLA | Managing Member | 6976 SPYGLASS AVENUE, PARKLAND, FL, 33076 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-31 |
| ANNUAL REPORT | 2023-01-27 |
| ANNUAL REPORT | 2022-02-17 |
| Reg. Agent Resignation | 2021-05-11 |
| ANNUAL REPORT | 2021-03-24 |
| ANNUAL REPORT | 2020-02-26 |
| ANNUAL REPORT | 2019-02-18 |
| ANNUAL REPORT | 2018-01-18 |
| ANNUAL REPORT | 2017-02-01 |
| ANNUAL REPORT | 2016-02-17 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
