| Entity Name: | KEYS PEDIATRICS PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 28 Sep 2016 (8 years ago) |
| Document Number: | L16000180830 |
| FEI/EIN Number | 81-4101986 |
| Address: | 3438 Duck Ave., KEY WEST, FL 33040 |
| Mail Address: | 4 W. Cypress Terr., KEY WEST, FL 33040 |
| ZIP code: | 33040 |
| County: | Monroe |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1326587734 | 2017-02-17 | 2018-03-28 | 1107 KEY PLZ, #268, KEY WEST, FL, 330404077, US | 1714 N ROOSEVELT BLVD, KEY WEST, FL, 330407299, US | |||||||||||||||||||||||||||||||
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| Phone | +1 727-543-8385 |
Authorized person
| Name | HEATHER RELLIAS |
| Role | ACCOUNT MANAGER |
| Phone | 8138674265 |
Taxonomy
| Taxonomy Code | 208000000X - Pediatrics Physician |
| License Number | ME11534 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 363LF0000X - Family Nurse Practitioner |
| License Number | ARNP9469600 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 010473800 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Blackwell, Curry | Agent | 2432 Flagler Ave., KEY WEST, FL 33040 |
| Name | Role | Address |
|---|---|---|
| Youschak, Melanie E, MD | Manager | 4 W Cypress Ter, Key West, FL 33040 |
| Name | Role | Address |
|---|---|---|
| Youschak, Scott R | Member | 4 W Cypress Ter, Key West, FL 33040 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-02-06 | 3438 Duck Ave., KEY WEST, FL 33040 | No data |
| CHANGE OF MAILING ADDRESS | 2023-02-22 | 3438 Duck Ave., KEY WEST, FL 33040 | No data |
| REGISTERED AGENT NAME CHANGED | 2023-02-22 | Blackwell, Curry | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-02-22 | 2432 Flagler Ave., KEY WEST, FL 33040 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-06 |
| ANNUAL REPORT | 2023-02-22 |
| ANNUAL REPORT | 2022-03-08 |
| ANNUAL REPORT | 2021-03-13 |
| ANNUAL REPORT | 2020-02-01 |
| ANNUAL REPORT | 2019-03-07 |
| ANNUAL REPORT | 2018-02-24 |
| ANNUAL REPORT | 2017-04-21 |
| Florida Limited Liability | 2016-09-28 |
Date of last update: 19 Jan 2025
Sources: Florida Department of State
