| Entity Name: | MOHIB MEDICAL LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 04 Aug 2014 (11 years ago) |
| Document Number: | L14000121414 |
| FEI/EIN Number | 47-1513372 |
| Address: | 10629 Emerald Chase Drive, Orlando, FL 32836 |
| Mail Address: | 10629 Emerald Chase Drive, Orlando, FL 32836 |
| ZIP code: | 32836 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1871020842 | 2017-05-22 | 2017-05-22 | 410 LIONEL WAY STE 200, DAVENPORT, FL, 338377809, US | 410 LIONEL WAY STE 200, DAVENPORT, FL, 338377809, US | |||||||||||||||||||||||
|
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| Phone | +1 863-353-2602 |
Authorized person
| Name | MR. MARK NICOLE |
| Role | MANAGER |
| Phone | 3212234470 |
Taxonomy
| Taxonomy Code | 261Q00000X - Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAL LICENSE |
| Number | ME105262 |
| Issuer | MEDICAID |
| Number | 266607300 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MOHIB, SAIYED | Agent | 10629 Emerald Chase Drive, Orlando, FL 32836 |
| Name | Role | Address |
|---|---|---|
| MOHIB, SAIYED | Manager | 10629 Emerald Chase Drive, Orlando, FL 32836 |
| Mehdi, Hina F | Manager | 10629 Emerald Chase Drive, Orlando, FL 32836 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2016-04-26 | 10629 Emerald Chase Drive, Orlando, FL 32836 | No data |
| CHANGE OF MAILING ADDRESS | 2016-04-26 | 10629 Emerald Chase Drive, Orlando, FL 32836 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2016-04-26 | 10629 Emerald Chase Drive, Orlando, FL 32836 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-02 |
| ANNUAL REPORT | 2024-06-04 |
| ANNUAL REPORT | 2023-03-30 |
| ANNUAL REPORT | 2022-03-21 |
| ANNUAL REPORT | 2021-04-03 |
| ANNUAL REPORT | 2020-03-30 |
| ANNUAL REPORT | 2019-03-26 |
| ANNUAL REPORT | 2018-03-18 |
| ANNUAL REPORT | 2017-02-24 |
| ANNUAL REPORT | 2016-04-26 |
Date of last update: 20 Feb 2025
Sources: Florida Department of State
