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SOUTH FLORIDA CRITICAL CARE SERVICES, LLC

Company Details

Entity Name: SOUTH FLORIDA CRITICAL CARE SERVICES, LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Active
Date Filed: 08 Dec 2017 (7 years ago)
Document Number: L17000252100
FEI/EIN Number 82-3699891
Address: 8370 W Flagler St, Ste 226, MIAMI, FL, 33144, US
Mail Address: 8370 W Flagler St, Ste 226, MIAMI, FL, 33144, US
ZIP code: 33144
County: Miami-Dade
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1306354626 2018-01-22 2024-06-26 PO BOX 282070, TAMPA, FL, 336302070, US 8370 W FLAGLER ST STE 226, MIAMI, FL, 331442040, US

Contacts

Phone +1 305-928-7249
Fax 3056303632

Authorized person

Name DOUGLAS PORTILLO
Role PRESIDENT
Phone 3052819398

Taxonomy

Taxonomy Code 207RC0200X - Critical Care Medicine (Internal Medicine) Physician
Is Primary Yes

Other Provider Identifiers

Issuer MEDICAID
Number 024311500
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
SOUTH FLORIDA CRITICAL CARE SERVICES, LLC 401(K) PLAN 2023 823699891 2024-04-26 SOUTH FLORIDA CRITICAL CARE SERVICES, LLC 123
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-01-01
Business code 621111
Sponsor’s telephone number 3056619404
Plan sponsor’s address 8600 SW 92ND STREET, SUITE 204B, MIAMI, FL, 33156

Signature of

Role Plan administrator
Date 2024-04-26
Name of individual signing VILMA QUINTANA
Valid signature Filed with authorized/valid electronic signature
SOUTH FLORIDA CRITICAL CARE SERVICES, LLC 401(K) PLAN 2022 823699891 2023-05-23 SOUTH FLORIDA CRITICAL CARE SERVICES, LLC 112
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-01-01
Business code 621111
Sponsor’s telephone number 3056619404
Plan sponsor’s address 8600 SW 92ND STREET, SUITE 204B, MIAMI, FL, 33156

Signature of

Role Plan administrator
Date 2023-05-23
Name of individual signing VILMA QUINTANA
Valid signature Filed with authorized/valid electronic signature
SOUTH FLORIDA CRITICAL CARE SERVICES, LLC 401(K) PLAN 2021 823699891 2022-08-19 SOUTH FLORIDA CRITICAL CARE SERVICES, LLC 81
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-01-01
Business code 621111
Sponsor’s telephone number 3056619404
Plan sponsor’s address 8600 SW 92ND STREET, SUITE 204B, MIAMI, FL, 33156

Signature of

Role Plan administrator
Date 2022-08-19
Name of individual signing DR DOUGLAS PORTILLO
Valid signature Filed with authorized/valid electronic signature
SOUTH FLORIDA CRITICAL CARE SERVICES, LLC 401(K) PLAN 2020 823699891 2021-09-07 SOUTH FLORIDA CRITICAL CARE SERVICES, LLC 31
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-01-01
Business code 621111
Sponsor’s telephone number 3056619404
Plan sponsor’s address 8600 SW 92ND STREET, STE #204B, MIAMI, FL, 33156

Signature of

Role Plan administrator
Date 2021-09-07
Name of individual signing DR DOUGLAS PORTILLO
Valid signature Filed with authorized/valid electronic signature
SOUTH FLORIDA CRITICAL CARE SERVICES, LLC 401(K) PLAN 2019 823699891 2020-10-12 SOUTH FLORIDA CRITICAL CARE SERVICES, LLC 23
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-01-01
Business code 621111
Sponsor’s telephone number 3056619404
Plan sponsor’s address 8600 SW 92ND STREET, STE #204B, MIAMI, FL, 33156

Signature of

Role Plan administrator
Date 2020-10-12
Name of individual signing DR DOUGLAS PORTILLO
Valid signature Filed with authorized/valid electronic signature
SOUTH FLORIDA CRITICAL CARE SERVICES, LLC 401(K) PLAN 2018 823699891 2019-10-08 SOUTH FLORIDA CRITICAL CARE SERVICES, LLC 17
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-01-01
Business code 621111
Sponsor’s telephone number 3056619404
Plan sponsor’s address 7000 SW 62ND AVE, STE #201, MIAMI, FL, 33143

Signature of

Role Plan administrator
Date 2019-10-08
Name of individual signing DR DOUGLAS PORTILLO
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
SCHERMER STEVEN J Agent 100 SE 3rd Ave, FORT LAUDERDALE, FL, 33394

Manager

Name Role Address
PEREZ-FERNANDEZ JAVIER Manager 8370 W Flagler St, MIAMI, FL, 33144

Member

Name Role Address
Portillo Douglas Member 8370 W Flagler St, MIAMI, FL, 33144
Fuentes Karel Member 8370 W Flagler St, MIAMI, FL, 33144
Rodriguez-Moran J. F Member 8370 W Flagler St, MIAMI, FL, 33144

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G18000037608 ICS EXPIRED 2018-03-21 2023-12-31 No data 7000 S.W. 62ND AVE, STE 201, MIAMI, FL, 33143
G18000037606 INTENSIVE CARE SOLUTIONS ACTIVE 2018-03-21 2028-12-31 No data 8370 W FLAGLER ST, STE 226, MIAMI, FL, 33144

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2023-04-06 8370 W Flagler St, Ste 226, MIAMI, FL 33144 No data
CHANGE OF MAILING ADDRESS 2023-04-06 8370 W Flagler St, Ste 226, MIAMI, FL 33144 No data
REGISTERED AGENT ADDRESS CHANGED 2023-04-06 100 SE 3rd Ave, Ste 1850, FORT LAUDERDALE, FL 33394 No data

Documents

Name Date
ANNUAL REPORT 2024-04-10
ANNUAL REPORT 2023-04-06
ANNUAL REPORT 2022-04-16
AMENDED ANNUAL REPORT 2021-08-05
ANNUAL REPORT 2021-04-27
ANNUAL REPORT 2020-04-24
ANNUAL REPORT 2019-02-27
ANNUAL REPORT 2018-07-19
Florida Limited Liability 2017-12-08

Date of last update: 01 Feb 2025

Sources: Florida Department of State