| Entity Name: | MY DME DOC LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 22 Sep 2014 (10 years ago) |
| Document Number: | L14000147711 |
| FEI/EIN Number | 47-1890453 |
| Address: | 6251 Chancellor Drive, Suite 119, Orlando, FL, 32809, US |
| Mail Address: | 6251 Chancellor Drive, Suite 119, Orlando, FL, 32809, US |
| ZIP code: | 32809 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1619353836 | 2015-08-11 | 2024-04-01 | PO BOX 24338, TAMPA, FL, 336234338, US | 977 DEL MAR DR, LADY LAKE, FL, 32159, US | |||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 866-726-9363 |
| Fax | 8887885796 |
Authorized person
| Name | MS. ROBIN L MENCHEN |
| Role | CHIEF EXECUTIVE OFFICER |
| Phone | 4078224600 |
Taxonomy
| Taxonomy Code | 332B00000X - Durable Medical Equipment & Medical Supplies |
| Is Primary | Yes |
| Taxonomy Code | 332BC3200X - Customized Equipment (DME) |
| Is Primary | No |
| Taxonomy Code | 332BP3500X - Parenteral & Enteral Nutrition Supplies (DME) |
| Is Primary | No |
| Taxonomy Code | 332BX2000X - Oxygen Equipment & Supplies (DME) |
| Is Primary | No |
| Taxonomy Code | 335E00000X - Prosthetic/Orthotic Supplier |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 118231300 |
| State | FL |
| Name | Role |
|---|---|
| C T CORPORATION SYSTEM | Agent |
| Name | Role | Address |
|---|---|---|
| Menchen Robin | President | 6251 Chancellor Drive, Suite 119, Orlando, FL, 32809 |
| Name | Role | Address |
|---|---|---|
| Burres Steven | Secretary | 6251 Chancellor Drive, Suite 119, Orlando, FL, 32809 |
| Name | Role | Address |
|---|---|---|
| Phan Nam | Chief Financial Officer | 6251 Chancellor Drive, Suite 119, Orlando, FL, 32809 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-04-24 | 6251 Chancellor Drive, Suite 119, Orlando, FL 32809 | No data |
| CHANGE OF MAILING ADDRESS | 2024-04-24 | 6251 Chancellor Drive, Suite 119, Orlando, FL 32809 | No data |
| REGISTERED AGENT NAME CHANGED | 2023-07-12 | C T CORPORATION SYSTEM | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-07-12 | 1200 SOUTH PINE ISLAND ROAD, Plantation, FL 33324 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-24 |
| AMENDED ANNUAL REPORT | 2023-09-13 |
| AMENDED ANNUAL REPORT | 2023-07-13 |
| AMENDED ANNUAL REPORT | 2023-07-12 |
| ANNUAL REPORT | 2023-04-10 |
| ANNUAL REPORT | 2022-04-27 |
| ANNUAL REPORT | 2021-04-13 |
| ANNUAL REPORT | 2020-03-24 |
| ANNUAL REPORT | 2019-04-16 |
| ANNUAL REPORT | 2018-04-12 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
