| Entity Name: | MID FLORIDA CARDIOVASCULAR CENTER, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 09 Sep 2014 (10 years ago) |
| Document Number: | L14000141069 |
| FEI/EIN Number | 47-1823381 |
| Address: | 400 Ave K SE Ste 5, WINTER HAVEN, FL 33880 |
| Mail Address: | PO Box 1398, WINTER HAVEN, FL 33882 |
| ZIP code: | 33880 |
| County: | Polk |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1215339817 | 2014-09-25 | 2014-09-25 | 209 RUBY LAKE LN, WINTER HAVEN, FL, 338843267, US | 209 RUBY LAKE LN, WINTER HAVEN, FL, 338843267, US | |||||||||||||||||||||
|
|||||||||||||||||||||||||
| Phone | +1 412-298-8626 |
| Fax | 8882359876 |
Authorized person
| Name | DR. SIVA K BHASHYAM |
| Role | M.D. |
| Phone | 4122988626 |
Taxonomy
| Taxonomy Code | 207RC0000X - Cardiovascular Disease Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 005959700 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BHASHYAM, SIVA | Agent | 209 RUBY LAKE LANE, WINTER HAVEN, FL 33884 |
| Name | Role | Address |
|---|---|---|
| BHASHYAM, SIVA | Manager | 209 RUBY LAKE LANE, WINTER HAVEN, FL 33884 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2018-02-21 | 400 Ave K SE Ste 5, WINTER HAVEN, FL 33880 | No data |
| CHANGE OF MAILING ADDRESS | 2018-02-21 | 400 Ave K SE Ste 5, WINTER HAVEN, FL 33880 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-21 |
| ANNUAL REPORT | 2023-02-13 |
| ANNUAL REPORT | 2022-02-21 |
| ANNUAL REPORT | 2021-03-04 |
| ANNUAL REPORT | 2020-05-05 |
| ANNUAL REPORT | 2019-02-20 |
| ANNUAL REPORT | 2018-02-21 |
| ANNUAL REPORT | 2017-02-24 |
| ANNUAL REPORT | 2016-03-14 |
| ANNUAL REPORT | 2015-04-21 |
Date of last update: 20 Feb 2025
Sources: Florida Department of State
