| Entity Name: | SANTURCE MEDICAL CENTER, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 17 May 2016 (9 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 30 Oct 2019 (5 years ago) |
| Document Number: | L16000096876 |
| FEI/EIN Number | 81-2879464 |
| Address: | 500 VONDERBURG DR, BRANDON, FL, 33511, US |
| Mail Address: | 500 VONDERBURG DR, BRANDON, FL, 33511, US |
| ZIP code: | 33511 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1649725029 | 2016-08-16 | 2022-07-21 | 500 VONDERBURG DR, SUITE 305, BRANDON, FL, 335115964, US | 500 VONDERBURG DR STE 305, BRANDON, FL, 335115976, US | |||||||||||||||||||||||
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| Phone | +1 813-624-9399 |
| Phone | +1 813-651-0005 |
| Fax | 8139027234 |
Authorized person
| Name | DR. ORLANDO E MIELES |
| Role | MD/CEO |
| Phone | 8136510005 |
Taxonomy
| Taxonomy Code | 208D00000X - General Practice Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1700149143 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Lopez Yulieth P | Agent | 500 VONDERBURG DR, BRANDON, FL, 33511 |
| Name | Role | Address |
|---|---|---|
| MIELES ORLANDO E | Chief Executive Officer | 500 Vonderburg Dr, Brandon, FL, 33511 |
| Name | Role | Address |
|---|---|---|
| Lopez Yulieth P | Manager | 500 VONDERBURG DR, BRANDON, FL, 33511 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2022-01-05 | Lopez, Yulieth Patricia | No data |
| REINSTATEMENT | 2019-10-30 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2019-10-30 | 500 VONDERBURG DR, SUITE 305E, BRANDON, FL 33511 | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2019-09-27 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2018-03-31 | 500 VONDERBURG DR, SUITE 305E, BRANDON, FL 33511 | No data |
| CHANGE OF MAILING ADDRESS | 2018-03-31 | 500 VONDERBURG DR, SUITE 305E, BRANDON, FL 33511 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-04 |
| ANNUAL REPORT | 2023-03-03 |
| ANNUAL REPORT | 2022-01-05 |
| ANNUAL REPORT | 2021-02-02 |
| ANNUAL REPORT | 2020-01-20 |
| REINSTATEMENT | 2019-10-30 |
| ANNUAL REPORT | 2018-03-31 |
| ANNUAL REPORT | 2017-05-12 |
| Florida Limited Liability | 2016-05-17 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
