| Entity Name: | PLANT CITY MEDICAL GROUP, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 17 Jan 2017 (8 years ago) |
| Document Number: | L17000012736 |
| FEI/EIN Number | 81-5162750 |
| Address: | 2021 N. WHEELER STREET, SUITE 200, PLANT CITY, FL 33563 |
| Mail Address: | 2021 N. WHEELER STREET, SUITE 200, PLANT CITY, FL 33563 |
| ZIP code: | 33563 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1730626656 | 2017-01-30 | 2020-03-10 | 2021 N WHEELER ST STE 100, PLANT CITY, FL, 335631860, US | 2021 N WHEELER ST STE 100, PLANT CITY, FL, 335631860, US | |||||||||||||
|
|||||||||||||||||
| Phone | +1 561-866-8186 |
Authorized person
| Name | DR. CHRISTOPHER KIRBY |
| Role | MEDICAL DIRECTOR |
| Phone | 8137565666 |
Taxonomy
| Taxonomy Code | 101YA0400X - Addiction (Substance Use Disorder) Counselor |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| HATTON, DAVID | Agent | 2960 WENTWORTH, WESTON, FL 33332 |
| Name | Role | Address |
|---|---|---|
| HATTON, DAVID | Manager | 600 WEST HILLSBORO BLVD SUITE 300, DEERFIELD BEACH, FL 33441 |
| JONAS, GARRY | Manager | 600 WEST HILLSBORO BLVD SUITE 300, DEERFIELD BEACH, FL 33441 |
| MODIST, SCOTT | Manager | 600 WEST HILLSBORO BLVD SUITE 300, DEERFIELD BEACH, FL 33441 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G20000125201 | WHITE SANDS RECOVERY AND WELLNESS | ACTIVE | 2020-09-25 | 2025-12-31 | No data | 2021 N WHEELER STREET SUITE 200, PLANT CITY, FL, 33563 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2020-09-15 | 2021 N. WHEELER STREET, SUITE 200, PLANT CITY, FL 33563 | No data |
| CHANGE OF MAILING ADDRESS | 2020-09-15 | 2021 N. WHEELER STREET, SUITE 200, PLANT CITY, FL 33563 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-11 |
| ANNUAL REPORT | 2023-01-19 |
| ANNUAL REPORT | 2022-02-14 |
| ANNUAL REPORT | 2021-01-14 |
| ANNUAL REPORT | 2020-03-02 |
| ANNUAL REPORT | 2019-02-12 |
| ANNUAL REPORT | 2018-03-08 |
| Florida Limited Liability | 2017-01-17 |
Date of last update: 19 Jan 2025
Sources: Florida Department of State
