| Entity Name: | PB MEDICAL GROUP, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 11 Sep 2015 (9 years ago) |
| Date of dissolution: | 06 Sep 2018 (6 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 06 Sep 2018 (6 years ago) |
| Document Number: | L15000155573 |
| FEI/EIN Number | 47-5077680 |
| Address: | 2290 10TH AVENUE NORTH, 201, LAKE WORTH, FL, 33461, US |
| Mail Address: | 2290 10TH AVENUE NORTH, 201, LAKE WORTH, FL, 33461, US |
| ZIP code: | 33461 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1366812943 | 2015-09-25 | 2015-09-28 | 2290 10TH AVE N STE 201, LAKE WORTH, FL, 334616609, US | 2290 10TH AVE N STE 201, LAKE WORTH, FL, 334616609, US | |||||||||||||
|
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| Phone | +1 561-225-2890 |
Authorized person
| Name | COLIN DAVIS WALLACE |
| Role | CO-FOUNDER AND CEO |
| Phone | 5612554135 |
Taxonomy
| Taxonomy Code | 101YA0400X - Addiction (Substance Use Disorder) Counselor |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| PERRY MARK C | Agent | 2400 EAST COMMERCIAL BOULEVARD, FORT LAUDERDALE, FL, 33308 |
| Name | Role | Address |
|---|---|---|
| Sporn Marc | Manager | 2290 10TH AVENUE NORTH, SUITE 201, LAKE WORTH, FL, 33461 |
| WALLACE COLIN | Manager | 2290 10TH AVENUE NORTH, SUITE 201, LAKE WORTH, FL, 33461 |
| ROSENTHAL EVAN S | Manager | 2290 10TH AVENUE NORTH, SUITE 201, LAKE WORTH, FL, 33461 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2025-10-01 | 2290 10TH AVENUE NORTH, 201, LAKE WORTH, FL 33461 | No data |
| CHANGE OF MAILING ADDRESS | 2025-10-01 | 2290 10TH AVENUE NORTH, 201, LAKE WORTH, FL 33461 | No data |
| CHANGE OF MAILING ADDRESS | 2024-10-01 | 2290 10TH AVENUE NORTH, 201, LAKE WORTH, FL 33461 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2024-10-01 | 2290 10TH AVENUE NORTH, 201, LAKE WORTH, FL 33461 | No data |
| VOLUNTARY DISSOLUTION | 2018-09-06 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2016-10-18 | PERRY, MARK C | No data |
| REINSTATEMENT | 2016-10-18 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2016-09-23 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2018-06-21 |
| ANNUAL REPORT | 2017-02-27 |
| REINSTATEMENT | 2016-10-18 |
| Florida Limited Liability | 2015-09-11 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
