| Entity Name: | ST. PETERSBURG PRIMARY CARE ASSOCIATES, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 13 Mar 2017 (8 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 30 Aug 2022 (2 years ago) |
| Document Number: | L17000056862 |
| FEI/EIN Number | 821199630 |
| Address: | 3030 N. ROCKY POINT DR., TAMPA, FL, 33607, US |
| Mail Address: | 3030 N. ROCKY POINT DR., TAMPA, FL, 33607, US |
| ZIP code: | 33607 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1265954085 | 2017-07-13 | 2017-07-13 | 6101 WEBB RD STE 203, TAMPA, FL, 336152865, US | 780 4TH AVE S, ST PETERSBURG, FL, 337014412, US | |||||||||||||||||||||||||
|
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| Phone | +1 813-269-6426 |
| Phone | +1 727-502-0052 |
Authorized person
| Name | PAUL M PULCINI |
| Role | DOCTOR |
| Phone | 8132696426 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | ME83175 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICARE UPIN |
| Number | G20297 |
| State | FL |
| Name | Role |
|---|---|
| C T CORPORATION SYSTEM | Agent |
| Name | Role | Address |
|---|---|---|
| PCA TOPCO, LLC | Authorized Member | 3030 N. ROCKY POINT DR., TAMPA, FL, 33607 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G21000165753 | MAXHEALTH | ACTIVE | 2021-12-16 | 2026-12-31 | No data | 3030 ROCKY POINT DR, STE 825, TAMAP, FL, 33607 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-03-01 | 3030 N. ROCKY POINT DR., SUITE 825, TAMPA, FL 33607 | No data |
| CHANGE OF MAILING ADDRESS | 2024-03-01 | 3030 N. ROCKY POINT DR., SUITE 825, TAMPA, FL 33607 | No data |
| LC AMENDMENT | 2022-08-30 | No data | No data |
| LC AMENDMENT | 2021-07-20 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2021-07-20 | C T CORPORATION SYSTEM | No data |
| LC AMENDMENT | 2017-04-20 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-01 |
| ANNUAL REPORT | 2023-02-27 |
| ANNUAL REPORT | 2022-04-16 |
| LC Amendment | 2021-07-20 |
| ANNUAL REPORT | 2021-04-22 |
| ANNUAL REPORT | 2020-06-18 |
| ANNUAL REPORT | 2019-03-08 |
| ANNUAL REPORT | 2018-03-16 |
| LC Amendment | 2017-04-20 |
| Florida Limited Liability | 2017-03-13 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
