| Entity Name: | PHYSICIAN PARTNERS MEDICAL GROUP LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Inactive |
| Date Filed: | 15 Mar 2016 (9 years ago) |
| Date of dissolution: | 15 Apr 2019 (6 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 15 Apr 2019 (6 years ago) |
| Document Number: | L16000053184 |
| FEI/EIN Number | 81-1868059 |
| Address: | 1521 E IRLO BRONSON MEMORIAL HWY, ST. CLOUD, FL 34771 |
| Mail Address: | 1521 E IRLO BRONSON MEMORIAL HWY, ST. CLOUD, FL 34771 |
| ZIP code: | 34771 |
| County: | Osceola |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1396190856 | 2016-05-03 | 2016-05-03 | 833 E OAK ST, KISSIMMEE, FL, 347445838, US | 833 E OAK ST, KISSIMMEE, FL, 347445838, US | |||||||||||||||||||||||
|
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| Phone | +1 321-422-4866 |
Authorized person
| Name | WILLIAM STEELE |
| Role | CEO |
| Phone | 5613850731 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | 207Q00000X |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | WELLCARE |
| Number | 11111 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Cardona, Carlos | Agent | 833 E Oak Street, Kissimmee, FL 34744 |
| Name | Role | Address |
|---|---|---|
| Cardona, Carlos | Manager | 833 E Oak Street, Kissimmee, FL 34744 |
| MERCADO, LOURDES | Manager | 1050 HIGHLAND CREST CIR, LAKE WALES, FL 33853 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2019-04-15 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2018-07-30 | 1521 E IRLO BRONSON MEMORIAL HWY, ST. CLOUD, FL 34771 | No data |
| CHANGE OF MAILING ADDRESS | 2018-07-30 | 1521 E IRLO BRONSON MEMORIAL HWY, ST. CLOUD, FL 34771 | No data |
| LC AMENDMENT | 2017-09-18 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2017-01-08 | Cardona, Carlos | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2017-01-08 | 833 E Oak Street, Kissimmee, FL 34744 | No data |
| Name | Date |
|---|---|
| VOLUNTARY DISSOLUTION | 2019-04-15 |
| ANNUAL REPORT | 2018-04-16 |
| LC Amendment | 2017-09-18 |
| ANNUAL REPORT | 2017-01-08 |
| Florida Limited Liability | 2016-03-15 |
Date of last update: 20 Jan 2025
Sources: Florida Department of State
