| Entity Name: | VERIMED HEALTH GROUP ZEPHYRHILLS, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 11 May 2017 (8 years ago) |
| Document Number: | L17000105117 |
| FEI/EIN Number | 82-1535610 |
| Address: | 37900 Daughtery Rd, ZEPHYRHILLS, FL, 33542, US |
| Mail Address: | 37900 Daughtery Rd, ZEPHYRHILLS, FL, 33542, US |
| ZIP code: | 33542 |
| County: | Pasco |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1891217972 | 2017-07-11 | 2024-06-05 | 37900 DAUGHTERY RD STE 1, ZEPHYRHILLS, FL, 335411316, US | 37900 DAUGHTERY RD STE 1, ZEPHYRHILLS, FL, 335411316, US | |||||||||||||||||||||||
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| Phone | +1 813-788-5531 |
| Fax | 8137837178 |
Authorized person
| Name | JULISSA ORTIZ |
| Role | ADMINISTRATOR |
| Phone | 7274011714 |
Taxonomy
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 018078400 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| REVELLO MARTIN | Agent | 26838 TANIC DRIVE, WESLEY CHAPEL, FL, 33544 |
| Name | Role |
|---|---|
| JJAM HEALTHCARE HOLDINGS, LLC | Authorized Member |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-06-18 | 37900 Daughtery Rd, Suite 1, ZEPHYRHILLS, FL 33542 | No data |
| CHANGE OF MAILING ADDRESS | 2024-06-18 | 37900 Daughtery Rd, Suite 1, ZEPHYRHILLS, FL 33542 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-26 |
| ANNUAL REPORT | 2023-02-14 |
| ANNUAL REPORT | 2022-04-19 |
| ANNUAL REPORT | 2021-04-30 |
| ANNUAL REPORT | 2020-06-30 |
| ANNUAL REPORT | 2019-04-25 |
| ANNUAL REPORT | 2018-04-16 |
| Florida Limited Liability | 2017-05-11 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
