| Entity Name: | INTEGRATED INDEPENDENT PHYSICIANS NETWORK, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 08 Apr 2015 (10 years ago) |
| Document Number: | L15000061658 |
| FEI/EIN Number | 47-2908425 |
| Address: | 1101 N. LAKE DESTINY ROAD, SUITE 300, MAITLAND, FL 32751 |
| Mail Address: | 1101 N. LAKE DESTINY ROAD, SUITE 300, MAITLAND, FL 32751 |
| ZIP code: | 32751 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1730783556 | 2020-11-23 | 2020-11-23 | 1101 N LAKE DESTINY RD STE 300, MAITLAND, FL, 327517121, US | 1101 N LAKE DESTINY RD STE 300, MAITLAND, FL, 327517121, US | |||||||||||||||
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| Phone | +1 407-475-9213 |
| Fax | 4074759203 |
Authorized person
| Name | KATHY MONNETT |
| Role | EXECUTIVE ASSISTA NT |
| Phone | 4074759213 |
Taxonomy
| Taxonomy Code | 302F00000X - Exclusive Provider Organization |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| JONES, LARRY E | Agent | 1101 N. LAKE DESTINY ROAD, SUITE 300, MAITLAND, FL 32751 |
| Name | Role | Address |
|---|---|---|
| CHAET, MARK, M.D. | Manager | 1101 N Lake Destiny Road, STE 300 Maitland, FL 32751 |
| Name | Role | Address |
|---|---|---|
| JONES, LARRY E | Authorized Representative | 1101 N. LAKE DESTINY ROAD, SUITE 300 MAITLAND, FL 32751 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2017-04-13 | JONES, LARRY E | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2017-04-13 | 1101 N. LAKE DESTINY ROAD, SUITE 300, MAITLAND, FL 32751 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2016-04-15 | 1101 N. LAKE DESTINY ROAD, SUITE 300, MAITLAND, FL 32751 | No data |
| CHANGE OF MAILING ADDRESS | 2016-04-15 | 1101 N. LAKE DESTINY ROAD, SUITE 300, MAITLAND, FL 32751 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-24 |
| ANNUAL REPORT | 2023-04-19 |
| ANNUAL REPORT | 2022-04-08 |
| ANNUAL REPORT | 2021-01-28 |
| ANNUAL REPORT | 2020-04-30 |
| ANNUAL REPORT | 2019-04-11 |
| ANNUAL REPORT | 2018-04-23 |
| ANNUAL REPORT | 2017-04-13 |
| ANNUAL REPORT | 2016-04-15 |
| Florida Limited Liability | 2015-04-08 |
Date of last update: 20 Feb 2025
Sources: Florida Department of State
