| Entity Name: | BALLAST MEDICAL MANAGEMENT, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 09 Jan 2018 (7 years ago) |
| Document Number: | L18000006639 |
| FEI/EIN Number | 82-3955665 |
| Address: | 9200 S. Dadeland Blvd, Ste 208, MIAMI, FL 33156 |
| Mail Address: | 9200 S. Dadeland Blvd, Ste 208, MIAMI, FL 33156 |
| ZIP code: | 33156 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1447768452 | 2018-01-12 | 2023-11-14 | 9200 S DADELAND BLVD STE 208, MIAMI, FL, 331562707, US | 9200 S DADELAND BLVD STE 208, MIAMI, FL, 331562707, US | |||||||||||||
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| Phone | +1 786-326-2830 |
Authorized person
| Name | MR. OMAR MONTESINO JR. |
| Role | CHIEF EXECUTIVE OFFICER |
| Phone | 7866152572 |
Taxonomy
| Taxonomy Code | 305R00000X - Preferred Provider Organization |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| Montesino, Omar | Agent | 9200 S. Dadeland Blvd, Ste: 208, Miami, FL 33156 |
| Name | Role | Address |
|---|---|---|
| MONTESINO, OMAR, JR. | Chief Executive Officer | 9200 S. DADELAND BLVD, STE 208 MIAMI, FL 33156 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2025-01-28 | 9200 S. Dadeland Blvd, Ste: 208, Miami, FL 33156 | No data |
| REGISTERED AGENT NAME CHANGED | 2024-01-05 | Montesino, Omar | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-01-05 | Ste: 208, Miami, FL 33156 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2023-10-20 | 9200 S. Dadeland Blvd, Ste 208, MIAMI, FL 33156 | No data |
| CHANGE OF MAILING ADDRESS | 2023-10-20 | 9200 S. Dadeland Blvd, Ste 208, MIAMI, FL 33156 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-28 |
| ANNUAL REPORT | 2024-01-05 |
| ANNUAL REPORT | 2023-01-26 |
| ANNUAL REPORT | 2022-01-05 |
| ANNUAL REPORT | 2021-01-04 |
| ANNUAL REPORT | 2020-01-21 |
| ANNUAL REPORT | 2019-02-04 |
| Florida Limited Liability | 2018-01-09 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 4023968008 | 2020-06-25 | 0455 | PPP | 6001 NW 153 ST, MIAMI LAKES, FL, 33014-2413 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 17 Feb 2025
Sources: Florida Department of State
