| Entity Name: | COLLINS PHYSICIAN SERVICES, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 21 Jun 2018 (7 years ago) |
| Document Number: | L18000152635 |
| FEI/EIN Number | 83-0988066 |
| Address: | 200 CORPORATE BLVD., LAFAYETTE, LA, 70508, US |
| Mail Address: | 200 CORPORATE BLVD., LAFAYETTE, LA, 70508, US |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1457839524 | 2018-08-01 | 2024-09-17 | 200 CORPORATE BLVD, LAFAYETTE, LA, 705083870, US | 4300 ALTON RD, MIAMI BEACH, FL, 331402948, US | |||||||||||||||||||||||||||||||||||
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| Phone | +1 800-893-9698 |
| Fax | 3372627246 |
| Phone | +1 305-481-9776 |
Authorized person
| Name | LISHA C FALK |
| Role | VP OF CONTRACTING |
| Phone | 3376091221 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 208M00000X - Hospitalist Physician |
| Is Primary | Yes |
| Taxonomy Code | 363A00000X - Physician Assistant |
| Is Primary | No |
| Taxonomy Code | 363L00000X - Nurse Practitioner |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 100712700 |
| State | FL |
| Name | Role |
|---|---|
| C T CORPORATION SYSTEM | Agent |
| Name | Role |
|---|---|
| THE SCHUMACHER GROUP OF FLORIDA, INC. | Authorized Member |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-14 |
| ANNUAL REPORT | 2023-02-17 |
| ANNUAL REPORT | 2022-02-23 |
| ANNUAL REPORT | 2021-02-05 |
| ANNUAL REPORT | 2020-02-04 |
| ANNUAL REPORT | 2019-03-22 |
| Florida Limited Liability | 2018-06-21 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
