| Entity Name: | EZEM ANESTHESIA LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 10 Dec 2018 (6 years ago) |
| Document Number: | L18000283024 |
| FEI/EIN Number | 83-3312159 |
| Address: | 4475 SW 179TH WAY, MIRAMAR, FL 33029 |
| Mail Address: | 4475 SW 179TH WAY, MIRAMAR, FL 33029 |
| ZIP code: | 33029 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1104442664 | 2020-06-22 | 2020-06-22 | 4475 SW 179TH WAY, MIRAMAR, FL, 330296305, US | 4475 SW 179TH WAY, MIRAMAR, FL, 330296305, US | |||||||||||||||||||
|
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| Phone | +1 786-295-1401 |
Authorized person
| Name | MRS. MARY EZEM |
| Role | AUTHORIZED OFFICIAL |
| Phone | 7862951401 |
Taxonomy
| Taxonomy Code | 163W00000X - Registered Nurse |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | LICENSE |
| Number | APRN9169221 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| EZEM, MARY | Agent | 4475 SW 179TH WAY, MIRAMAR, FL 33029 |
| Name | Role | Address |
|---|---|---|
| EZEM, SAM | Manager | 4475 SW 179TH WAY, MIRAMAR, FL 33029 |
| EZEM, MARY | Manager | 4475 SW 179TH WAY, MIRAMAR, FL 33029 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-24 |
| ANNUAL REPORT | 2023-04-04 |
| ANNUAL REPORT | 2022-01-29 |
| ANNUAL REPORT | 2021-01-30 |
| ANNUAL REPORT | 2020-03-18 |
| ANNUAL REPORT | 2019-03-03 |
| Florida Limited Liability | 2018-12-10 |
Date of last update: 16 Feb 2025
Sources: Florida Department of State
