| Entity Name: | W. THOMAS MEDICAL, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 29 Sep 2016 (8 years ago) |
| Last Event: | LC STMNT OF RA/RO CHG |
| Event Date Filed: | 15 Sep 2017 (7 years ago) |
| Document Number: | L16000181724 |
| FEI/EIN Number | 81-4012446 |
| Address: | 10936 NW 41ST DR, CORAL SPRINGS, FL 33065 |
| Mail Address: | 10936 NW 41ST DR, CORAL SPRINGS, FL 33065 |
| ZIP code: | 33065 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1801462858 | 2021-06-01 | 2021-09-23 | 2784 SW 129TH TER, MIRAMAR, FL, 330273852, US | 300 EXECUTIVE CENTER DR, WEST PALM BEACH, FL, 334014842, US | |||||||||||||||||||||
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| Phone | +1 561-201-3234 |
| Phone | +1 561-471-5566 |
Authorized person
| Name | DR. WALLACE THOMAS |
| Role | OWNER |
| Phone | 5612013234 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 110589000 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| THOMAS, WALLACE | Agent | 10936 NW 41ST DR, CORAL SPRINGS, FL 33065 |
| Name | Role | Address |
|---|---|---|
| THOMAS, WALLACE | Authorized Member | 10936 NW 41ST DR, CORAL SPRINGS, FL 33065 |
| OTERO DIAZ, INELISSE | Authorized Member | 10936 NW 41ST DR, CORAL SPRINGS, FL 33065 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2024-05-01 | 10936 NW 41ST DR, CORAL SPRINGS, FL 33065 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2023-07-20 | 10936 NW 41ST DR, CORAL SPRINGS, FL 33065 | No data |
| CHANGE OF MAILING ADDRESS | 2023-07-20 | 10936 NW 41ST DR, CORAL SPRINGS, FL 33065 | No data |
| LC STMNT OF RA/RO CHG | 2017-09-15 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-05-01 |
| ANNUAL REPORT | 2023-05-01 |
| ANNUAL REPORT | 2022-05-01 |
| ANNUAL REPORT | 2021-05-01 |
| ANNUAL REPORT | 2020-04-08 |
| ANNUAL REPORT | 2019-05-01 |
| ANNUAL REPORT | 2018-04-19 |
| CORLCRACHG | 2017-09-15 |
| ANNUAL REPORT | 2017-04-21 |
| Florida Limited Liability | 2016-09-29 |
Date of last update: 19 Jan 2025
Sources: Florida Department of State
