| Entity Name: | PHYSICIAN GROUP HOLDINGS, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 07 Aug 2018 (6 years ago) |
| Document Number: | L18000188484 |
| FEI/EIN Number | 83-1512090 |
| Address: | 1375 MARSH HARBOR DRIVE, JACKSONVILLE, FL, 32225, US |
| Mail Address: | 1375 MARSH HARBOR DRIVE, JACKSONVILLE, FL, 32225, US |
| ZIP code: | 32225 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1003478827 | 2019-07-01 | 2019-07-01 | 10210 SAN JOSE BLVD STE 4, JACKSONVILLE, FL, 322576271, US | 10210 SAN JOSE BLVD STE 4, JACKSONVILLE, FL, 322576271, US | |||||||||||||||
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| Phone | +1 904-990-8484 |
| Fax | 9049908485 |
Authorized person
| Name | DR. MEGAN ELIZABETH DEACON-CASEY |
| Role | MEDICAL DIRECTOR |
| Phone | 9049908484 |
Taxonomy
| Taxonomy Code | 2085R0204X - Vascular & Interventional Radiology Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| CASEY HUGH | Agent | 1375 MARSH HARBOR DRIVE, JACKSONVILLE, FL, 32225 |
| Name | Role | Address |
|---|---|---|
| DEACON-CASEY MEGAN E | Manager | 1375 MARSH HARBOR DRIVE, JACKSONVILLE, FL, 32225 |
| BOWEN-WELLS CAROL P | Manager | 6420 San Juan Avenue, JACKSONVILLE, FL, 32210 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G19000073004 | AGELESS VEIN CENTER | EXPIRED | 2019-07-01 | 2024-12-31 | No data | 10210 SAN JOSE BLVD, JACKSONVILLE, FL, 32257 |
| G18000099613 | AGELESS REJUVENATION CENTER | EXPIRED | 2018-09-08 | 2023-12-31 | No data | 1375 MARSH HARBOR DRIVE, JACKSONVILLE, FL, 32225 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-29 |
| ANNUAL REPORT | 2023-04-30 |
| ANNUAL REPORT | 2022-04-29 |
| ANNUAL REPORT | 2021-04-26 |
| ANNUAL REPORT | 2020-06-06 |
| ANNUAL REPORT | 2019-04-25 |
| Florida Limited Liability | 2018-08-07 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
