| Entity Name: | AG PEDIATRICS, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 06 Dec 2017 (7 years ago) |
| Date of dissolution: | 03 Jul 2020 (5 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 03 Jul 2020 (5 years ago) |
| Document Number: | L17000250252 |
| FEI/EIN Number | 823662954 |
| Address: | 7645 CITA LANE, UNIT 102, NEW PORT RICHEY, FL, 34653, US |
| Mail Address: | 7645 CITA LANE, UNIT 102, NEW PORT RICHEY, FL, 34653, US |
| ZIP code: | 34653 |
| County: | Pasco |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1891201919 | 2017-12-27 | 2017-12-27 | 7645 CITA LN UNIT 102, NEW PORT RICHEY, FL, 346536220, US | 7645 CITA LN UNIT 102, NEW PORT RICHEY, FL, 346536220, US | |||||||||||||||||||||||||
|
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| Phone | +1 727-261-6464 |
| Fax | 7272616458 |
Authorized person
| Name | REDA AWAD |
| Role | OWNER |
| Phone | 7272616464 |
Taxonomy
| Taxonomy Code | 208000000X - Pediatrics Physician |
| License Number | ME110635 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 010501900 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Awad Reda | Agent | 7645 CITA LANE, NEW PORT RICHEY, FL, 34653 |
| Name | Role | Address |
|---|---|---|
| AWAD REDA | Authorized Member | 7645 CITA LANE, NEW PORT RICHEY, FL, 34653 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G18000003057 | ST. THOMAS PEDIATRICS ASSOCIATES | EXPIRED | 2018-01-05 | 2023-12-31 | No data | 7645 CITA LANE, UNIT 102, NEW PORT RICHEY, FL, 34653 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2020-07-03 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2019-02-11 | Awad, Reda | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2019-02-11 | 7645 CITA LANE, UNIT 102, NEW PORT RICHEY, FL 34653 | No data |
| LC AMENDMENT | 2017-12-28 | No data | No data |
| Name | Date |
|---|---|
| VOLUNTARY DISSOLUTION | 2020-07-03 |
| ANNUAL REPORT | 2019-02-11 |
| LC Amendment | 2017-12-28 |
| Florida Limited Liability | 2017-12-06 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
