| Entity Name: | VARGAS MEDICAL SERVICES, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 04 Oct 2018 (6 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 01 Oct 2023 (a year ago) |
| Document Number: | L18000235109 |
| FEI/EIN Number | 83-2158370 |
| Address: | 4190 RICHWOOD COURT, MERRITT ISLAND, FL, 32952 |
| Mail Address: | 4190 RICHWOOD COURT, MERRITT ISLAND, FL, 32952, US |
| ZIP code: | 32952 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1245706423 | 2018-10-16 | 2019-08-05 | 4190 RICHWOOD CT, MERRITT ISLAND, FL, 329526237, US | 606 SHERIDAN RD, MELBOURNE, FL, 329013227, US | |||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 321-727-0984 |
| Fax | 3217273606 |
Authorized person
| Name | DR. VICTOR M VARGAS |
| Role | OWNER |
| Phone | 3217270984 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 208M00000X - Hospitalist Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 101937700 |
| State | FL |
| Issuer | RRMEDICARE PTAN |
| Number | DY8418 |
| State | FL |
| Issuer | MEDICARE PTAN |
| Number | KQ811 |
| State | FL |
| Issuer | BCBS |
| Number | RO9Q1 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| VARGAS VICTOR M | Agent | 4190 RICHWOOD COURT, MERRITT ISLAND, FL, 32952 |
| Name | Role | Address |
|---|---|---|
| VARGAS VICTOR MMD | Manager | 4190 RICHWOOD COURT, MERRITT ISLAND, FL, 32952 |
| VARGAS ADRIENNE M | Manager | 4190 RICHWOOD COURT, MERRITT ISLAND, FL, 32952 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2023-10-01 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2023-10-01 | VARGAS, VICTOR M | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2022-09-23 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-29 |
| REINSTATEMENT | 2023-10-01 |
| ANNUAL REPORT | 2021-03-16 |
| ANNUAL REPORT | 2020-03-31 |
| ANNUAL REPORT | 2019-02-08 |
| Florida Limited Liability | 2018-10-04 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
