| Entity Name: | PALM MEDICAL CENTER LAKELAND, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 24 Jan 2018 (7 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 25 Oct 2024 (3 months ago) |
| Document Number: | L18000020947 |
| FEI/EIN Number | 37-1879497 |
| Address: | 135 E 1ST ST, LAKELAND, FL 33805-4609 |
| Mail Address: | 2600 DOUGLAS RD,, SUITE 308, CORAL GABLES, FL 33134 |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1346005675 | 2024-02-15 | 2024-02-15 | 2600 S DOUGLAS RD STE 308, CORAL GABLES, FL, 331346134, US | 249 US HIGHWAY 27 N, SEBRING, FL, 338702132, US | |||||||||||||||||
|
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| Phone | +1 813-538-7880 |
| Phone | +1 863-593-4333 |
| Fax | 8634530745 |
Authorized person
| Name | SANTIAGO MOISES MARTIN |
| Role | PRESIDENT OF CENTER OPERATIONS |
| Phone | 3059139441 |
Taxonomy
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| Is Primary | Yes |
| Name | Role |
|---|---|
| CORPORATE CREATIONS NETWORK INC. | Agent |
| Name | Role | Address |
|---|---|---|
| CASILLAS, PATRICIO | Chief Operating Officer | 135 E 1ST ST, LAKELAND, FL 33805-4609 |
| Name | Role | Address |
|---|---|---|
| CHOUDHRY, FOWAD | Chief Executive Officer | 135 E 1ST ST, LAKELAND, FL 33805-4609 |
| Name | Role | Address |
|---|---|---|
| LEAL, JUAN | Vice President | 135 E 1ST ST, LAKELAND, FL 33805-4609 |
| Name | Role | Address |
|---|---|---|
| LEAL, JUAN | Founder | 135 E 1ST ST, LAKELAND, FL 33805-4609 |
| Name | Role | Address |
|---|---|---|
| LEAL, JUAN | Executive Producer | 135 E 1ST ST, LAKELAND, FL 33805-4609 |
| Name | Role | Address |
|---|---|---|
| LEAL, JUAN | Administrator | 135 E 1ST ST, LAKELAND, FL 33805-4609 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC AMENDMENT | 2024-10-25 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-03-25 | 801 US HIGHWAY 1, NORTH PALM BEACH, FL 33408 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2018-07-31 | 135 E 1ST ST, LAKELAND, FL 33805-4609 | No data |
| Name | Date |
|---|---|
| LC Amendment | 2024-10-25 |
| ANNUAL REPORT | 2024-04-04 |
| AMENDED ANNUAL REPORT | 2023-10-19 |
| ANNUAL REPORT | 2023-01-19 |
| AMENDED ANNUAL REPORT | 2022-03-31 |
| ANNUAL REPORT | 2022-01-04 |
| AMENDED ANNUAL REPORT | 2021-11-22 |
| ANNUAL REPORT | 2021-01-14 |
| ANNUAL REPORT | 2020-01-17 |
| ANNUAL REPORT | 2019-03-27 |
Date of last update: 18 Jan 2025
Sources: Florida Department of State
