| Entity Name: | ADVANCE MEDICAL SPECIALTY, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 14 Jun 2017 (8 years ago) |
| Document Number: | L17000130554 |
| FEI/EIN Number | 82-1920577 |
| Address: | 1576 Bella Cruz Drive, SUITE 363, The Villages, FL, 32159-8969, US |
| Mail Address: | 1576 Bella Cruz Drive, SUITE 363, The Villages, FL, 32159-8969, US |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1114449345 | 2017-07-10 | 2024-06-05 | 18981 US HIGHWAY 441 STE 121, MOUNT DORA, FL, 327576735, US | 8550 NE 138TH LN STE 500, LADY LAKE, FL, 321596804, US | |||||||||||||||||||||||||||||
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| Phone | +1 352-201-5949 |
| Fax | 3527292287 |
| Phone | +1 352-633-9858 |
| Fax | 3526339870 |
Authorized person
| Name | HEMWATTIE S JAIMANGAL |
| Role | PRESIDENT |
| Phone | 3526339858 |
Taxonomy
| Taxonomy Code | 207RI0200X - Infectious Disease Physician |
| License Number | OS10278 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 021679600 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| NEIKIRK JUDITH A | Agent | 1576 Bella Cruz Drive, The Villages, FL, 321598969 |
| Name | Role | Address |
|---|---|---|
| JAIMANGAL HEMWATTIE S | Manager | 1576 Bella Cruz Drive, The Villages, FL, 321598969 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2021-04-15 | 1576 Bella Cruz Drive, SUITE 363, The Villages, FL 32159-8969 | No data |
| CHANGE OF MAILING ADDRESS | 2021-04-15 | 1576 Bella Cruz Drive, SUITE 363, The Villages, FL 32159-8969 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-04-15 | 1576 Bella Cruz Drive, SUITE 363, The Villages, FL 32159-8969 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-16 |
| ANNUAL REPORT | 2023-04-22 |
| ANNUAL REPORT | 2022-04-29 |
| ANNUAL REPORT | 2021-04-15 |
| ANNUAL REPORT | 2020-04-26 |
| ANNUAL REPORT | 2019-04-29 |
| ANNUAL REPORT | 2018-03-11 |
| Florida Limited Liability | 2017-06-14 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
