| Entity Name: | MEDSTATION ORLANDO PRIMARY CARE LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 16 Aug 2016 (8 years ago) |
| Date of dissolution: | 10 May 2017 (8 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 10 May 2017 (8 years ago) |
| Document Number: | L16000153663 |
| Address: | 1601 PARK CENTER DR STE 9, ORLANDO, FL, 32835 |
| Mail Address: | 1601 PARK CENTER DR STE 9, ORLANDO, FL, 32835 |
| ZIP code: | 32835 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1316496003 | 2016-09-23 | 2016-09-23 | 1601 PARK CENTER DR, SUITE # 9, ORLANDO, FL, 328355700, US | 1601 PARK CENTER DR, SUITE # 9, ORLANDO, FL, 328355700, US | |||||||||||||||||||||||||||||||
|
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| Phone | +1 321-219-9301 |
| Fax | 9545826715 |
Authorized person
| Name | JAIME COLOMBINO GONZALEZ |
| Role | AMBR |
| Phone | 3523945535 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | ME0049457 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | NPI |
| Number | 1316936461 |
| State | FL |
| Issuer | MEDICAID |
| Number | 006455900 |
| State | FL |
| Name | Role |
|---|---|
| CSG - CAPITAL SERVICES GROUP, INC. | Agent |
| Name | Role | Address |
|---|---|---|
| GONZALEZ JAIME C | Authorized Member | 1601 PARK CENTER DR STE 9, ORLANDO, FL, 32835 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2017-05-10 | No data | No data |
| Name | Date |
|---|---|
| Florida Limited Liability | 2016-08-16 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
