| Entity Name: | RELIANCE MEDICAL ASSOCIATES OF JAX, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 05 Jan 2017 (8 years ago) |
| Document Number: | L17000004508 |
| FEI/EIN Number | 81-4868009 |
| Address: | 514 HERON LANDING ROADD, SAINT JOHNS, FL, 32259, UN |
| Mail Address: | 514 HERON LANDING ROADD, SAINT JOHNS, FL, 32259, UN |
| ZIP code: | 32259 |
| County: | St. Johns |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1023522315 | 2017-11-22 | 2023-07-10 | 2220 COUNTY ROAD 210 W STE 108, PMB 257, ST JOHNS, FL, 322594060, US | 8833 PERIMETER PARK BLVD STE 503, JACKSONVILLE, FL, 322161110, US | |||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 321-506-3925 |
| Phone | +1 904-687-1055 |
| Fax | 9046872141 |
Authorized person
| Name | DR. VISHAL C PATEL |
| Role | PHYSICIAN |
| Phone | 3215063925 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | ME121788 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | ME121788 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 208D00000X - General Practice Physician |
| License Number | ME121788 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| License Number | ME121788 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 108669600 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| PATEL VISHAL C | Agent | 514 HERON LANDING ROADD, SAINT JOHNS, FL, 32259 |
| Name | Role | Address |
|---|---|---|
| PATEL VISHAL C | Manager | 514 HERON LANDING ROADD, SAINT JOHNS, FL, 32259 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G21000135070 | RELIANCE PRIMARY & URGENT CARE | ACTIVE | 2021-10-07 | 2026-12-31 | No data | 514 HERON LANDING RD, ST JOHNS, FL, 32259 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-05 |
| ANNUAL REPORT | 2023-02-16 |
| ANNUAL REPORT | 2022-02-13 |
| ANNUAL REPORT | 2021-01-19 |
| ANNUAL REPORT | 2020-01-06 |
| ANNUAL REPORT | 2019-01-20 |
| ANNUAL REPORT | 2018-01-24 |
| Florida Limited Liability | 2017-01-05 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
