| Entity Name: | RANDALL L. BRADDOM, MD, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 30 Jul 2018 (7 years ago) |
| Last Event: | LC NAME CHANGE |
| Event Date Filed: | 15 Oct 2018 (6 years ago) |
| Document Number: | L18000182508 |
| FEI/EIN Number | 82-4797548 |
| Mail Address: | 9300 Conroy Windermere Rd, P O Box 1503, Windermere, FL 34786 |
| Address: | 1093 GOLDEN GROVE DRIVE, THE VILLAGES, FL 32162 |
| ZIP code: | 32162 |
| County: | Sumter |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1457820920 | 2018-11-14 | 2018-11-14 | 1093 GOLDEN GROVE DR, THE VILLAGES, FL, 321624023, US | 1451 EL CAMINO REAL, THE VILLAGES, FL, 321590041, US | |||||||||||||||
|
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| Phone | +1 908-601-7036 |
| Phone | +1 352-751-8000 |
Authorized person
| Name | RANDALL L BRADDOM |
| Role | OWNER/PHYSICIAN |
| Phone | 9086017036 |
Taxonomy
| Taxonomy Code | 208100000X - Physical Medicine & Rehabilitation Physician |
| Is Primary | Yes |
| Name | Role |
|---|---|
| CRESTVILLE ACCOUNTING, LLC | Agent |
| Name | Role | Address |
|---|---|---|
| BRADDOM, RANDALL | Manager | 1093 GOLDEN GROVE DRIVE, THE VILLAGES, FL 32162 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2021-01-16 | 1093 GOLDEN GROVE DRIVE, THE VILLAGES, FL 32162 | No data |
| REGISTERED AGENT NAME CHANGED | 2021-01-16 | Crestville Accounting, LLC | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-01-16 | 9300 Conroy Windermere Rd, PO Box 1503, Windermere, FL 34786 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2020-06-18 | 1093 GOLDEN GROVE DRIVE, THE VILLAGES, FL 32162 | No data |
| LC NAME CHANGE | 2018-10-15 | RANDALL L. BRADDOM, MD, LLC | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-07 |
| ANNUAL REPORT | 2023-01-31 |
| ANNUAL REPORT | 2022-01-26 |
| ANNUAL REPORT | 2021-01-16 |
| ANNUAL REPORT | 2020-06-18 |
| ANNUAL REPORT | 2019-01-25 |
| LC Name Change | 2018-10-15 |
| Florida Limited Liability | 2018-07-30 |
Date of last update: 17 Jan 2025
Sources: Florida Department of State
