| Entity Name: | CAPERNAUM MEDICAL CENTER FOR KIDS PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 14 Oct 2016 (8 years ago) |
| Document Number: | L16000190547 |
| FEI/EIN Number | 38-4016915 |
| Address: | 2024 Edgewood Dr S, LAKELAND, FL, 33803, US |
| Mail Address: | 2024 Edgewood Dr S, LAKELAND, FL, 33803, US |
| ZIP code: | 33803 |
| County: | Polk |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1518432038 | 2018-10-11 | 2018-10-11 | 5129 S LAKELAND DR STE 1, LAKELAND, FL, 338132599, US | 5129 S. LAKLAND DRIVE, SUITE 1, LAKELAND, FL, 338132599, US | |||||||||||||||||||||
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| Phone | +1 863-232-4323 |
| Fax | 8633375728 |
Authorized person
| Name | ERIC ROBERTO VERNIER |
| Role | MD/PRESIDENT |
| Phone | 8632324323 |
Taxonomy
| Taxonomy Code | 261QM2500X - Medical Specialty Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 019415800 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| VERNIER ERIC R | Agent | 2024 Edgewood Dr S, LAKELAND, FL, 33803 |
| Name | Role | Address |
|---|---|---|
| VERNIER ERIC R | Manager | 2024 Edgewood Dr S, LAKELAND, FL, 33803 |
| Vernier Eric | Manager | 2024 Edgewood Dr S, LAKELAND, FL, 33803 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G18000102348 | CAPERNAUM MEDICAL CENTER FOR KIDS TAMPA, HOUSE OF ANDREW | EXPIRED | 2018-09-17 | 2023-12-31 | No data | 5129 S. LAKELAND DRIVE, UNIT 2, LAKELAND, FL, 33813 |
| G18000102354 | CAPERNAUM MEDICAL CENTER FOR KIDS LAKELAND, HOUSE OF JOHN | EXPIRED | 2018-09-17 | 2023-12-31 | No data | 5129 S. LAKELAND DRIVE, UNIT 2, LAKELAND, FL, 33813 |
| G18000102355 | CAPERNAUM MEDICAL CENTER FOR KIDS KISSIMMEE, HOUSE OF JAMES | EXPIRED | 2018-09-17 | 2023-12-31 | No data | 5129 S. LAKELAND DRIVE, UNIT 2, LAKELAND, FL, 33813 |
| G16000114757 | CAPERNAUM KIDS LAKELAND | ACTIVE | 2016-10-21 | 2026-12-31 | No data | 5129 SOUTH LAKELAND DRIVE, UNIT 2, LAKELAND, FL, 33813 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-03-01 | 2024 Edgewood Dr S, LAKELAND, FL 33803 | No data |
| CHANGE OF MAILING ADDRESS | 2023-03-01 | 2024 Edgewood Dr S, LAKELAND, FL 33803 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-03-01 | 2024 Edgewood Dr S, LAKELAND, FL 33803 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-05-01 |
| ANNUAL REPORT | 2023-03-01 |
| ANNUAL REPORT | 2022-03-08 |
| ANNUAL REPORT | 2021-04-06 |
| ANNUAL REPORT | 2020-03-18 |
| ANNUAL REPORT | 2019-02-06 |
| ANNUAL REPORT | 2018-06-28 |
| ANNUAL REPORT | 2017-04-09 |
| Florida Limited Liability | 2016-10-14 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
