| Entity Name: | PALM BEACH HEART & VASCULAR, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 27 Aug 2018 (6 years ago) |
| Date of dissolution: | 31 Jul 2024 (6 months ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 31 Jul 2024 (6 months ago) |
| Document Number: | L18000205358 |
| FEI/EIN Number | 83-1751706 |
| Address: | 2609 W WOOLBRIGHT ROAD, SUITE 4, BOYNTON BEACH, FL, 33436, US |
| Mail Address: | 2609 W WOOLBRIGHT ROAD, SUITE 4, BOYNTON BEACH, FL, 33436, US |
| ZIP code: | 33436 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1174174239 | 2019-09-20 | 2023-06-09 | 2609 W WOOLBRIGHT RD STE 4, BOYNTON BEACH, FL, 334366634, US | 2609 W WOOLBRIGHT RD STE 4, BOYNTON BEACH, FL, 334366634, US | |||||||||||||||||||||||||
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| Phone | +1 561-500-5347 |
| Fax | 5612645347 |
Authorized person
| Name | PAUL MICHAEL |
| Role | PRESIDENT |
| Phone | 5615005347 |
Taxonomy
| Taxonomy Code | 207RC0000X - Cardiovascular Disease Physician |
| Is Primary | No |
| Taxonomy Code | 207RI0011X - Interventional Cardiology Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 015021200 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MICHAEL PAUL | Agent | 2609 W WOOLBRIGHT ROAD, BOYNTON BEACH, FL, 33436 |
| Name | Role | Address |
|---|---|---|
| MICHAEL PAUL | Manager | 2609 W WOOLBRIGHT ROAD, BOYNTON BEACH, FL, 33436 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2024-07-31 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-01-26 | 2609 W WOOLBRIGHT ROAD, SUITE 4, BOYNTON BEACH, FL 33436 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2020-11-05 | 2609 W WOOLBRIGHT ROAD, SUITE 4, BOYNTON BEACH, FL 33436 | No data |
| CHANGE OF MAILING ADDRESS | 2020-11-02 | 2609 W WOOLBRIGHT ROAD, SUITE 4, BOYNTON BEACH, FL 33436 | No data |
| Name | Date |
|---|---|
| VOLUNTARY DISSOLUTION | 2024-07-31 |
| ANNUAL REPORT | 2023-01-25 |
| ANNUAL REPORT | 2022-01-28 |
| ANNUAL REPORT | 2021-01-26 |
| ANNUAL REPORT | 2020-01-15 |
| ANNUAL REPORT | 2019-04-29 |
| Florida Limited Liability | 2018-08-27 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
