| Entity Name: | REID PHYSICIANS GROUP OF JACKSONVILLE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 23 Sep 2015 (9 years ago) |
| Document Number: | L15000162304 |
| FEI/EIN Number | 47-5161700 |
| Address: | 9550 Regency Square Blvd, Suite 200, JACKSONVILLE, FL, 32225, US |
| Mail Address: | 9550 Regency Square Blvd, Suite 200, JACKSONVILLE, FL, 32225, US |
| ZIP code: | 32225 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1679946735 | 2015-11-10 | 2016-06-03 | 1205 MONUMENT RD, SUITE 201, JACKSONVILLE, FL, 322256482, US | 1205 MONUMENT RD, SUITE 202, JACKSONVILLE, FL, 322256482, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 904-646-4225 |
| Fax | 9046464227 |
Authorized person
| Name | DR. ANA AMELIA SANCHEZ |
| Role | MEDICAL DIRECTOR |
| Phone | 9046464225 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | ME85541 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 363LF0000X - Family Nurse Practitioner |
| License Number | ARNP9389534 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 268855700 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MEYER ALBERT R | Agent | 55 S.E. 2ND AVE, 1ST FLOOR, DELRAY BEACH, FL, 33444 |
| Name | Role | Address |
|---|---|---|
| REID CAROLYN C | Manager | 1205 MONUMENT RD, SUITE 201, JACKSONVILLE, FL, 32225 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-10-03 | 9550 Regency Square Blvd, Suite 200, JACKSONVILLE, FL 32225 | No data |
| CHANGE OF MAILING ADDRESS | 2024-10-03 | 9550 Regency Square Blvd, Suite 200, JACKSONVILLE, FL 32225 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-27 |
| ANNUAL REPORT | 2023-03-30 |
| ANNUAL REPORT | 2022-03-15 |
| ANNUAL REPORT | 2021-01-14 |
| ANNUAL REPORT | 2020-03-16 |
| ANNUAL REPORT | 2019-01-16 |
| ANNUAL REPORT | 2018-02-21 |
| ANNUAL REPORT | 2017-03-07 |
| ANNUAL REPORT | 2016-04-27 |
| Florida Limited Liability | 2015-09-23 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
