| Entity Name: | HEALTH FIRST PRIVIA MEDICAL GROUP, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 29 Jan 2019 (6 years ago) |
| Document Number: | L19000030262 |
| FEI/EIN Number | 32-0602652 |
| Address: | 6450 US HIGHWAY 1, ROCKLEDGE, FL, 32955, US |
| Mail Address: | 6450 US Highway 1, Rockledge, FL, 32955, US |
| ZIP code: | 32955 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1700649043 | 2024-01-31 | 2024-05-28 | 3300 S FISKE BLVD, ROCKLEDGE, FL, 329554306, US | 140 6TH AVE, INDIALANTIC, FL, 329033204, US | |||||||||||||||
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| Phone | +1 321-434-5055 |
| Phone | +1 321-312-3501 |
Authorized person
| Name | LORA MORSE |
| Role | VP PROFESSIONAL FEE SERVICES |
| Phone | 3214346116 |
Taxonomy
| Taxonomy Code | 208D00000X - General Practice Physician |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| PRIVIA MEDICAL GROUP 401(K) PLAN | 2023 | 320602652 | 2024-07-23 | HEALTH FIRST PRIVIA MEDICAL GROUP, LLC | 125 | |||||||||||||
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| PRIVIA MEDICAL GROUP 401(K) PLAN | 2022 | 320602652 | 2023-10-15 | HEALTH FIRST PRIVIA MEDICAL GROUP, LLC | 45 | |||||||||||||
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| Name | Role | Address |
|---|---|---|
| ROMANELLO NICHOLAS W | Agent | 6450 US Highway 1, Rockledge, FL, 32955 |
| Name | Role |
|---|---|
| HEALTH FIRST MEDICAL GROUP, LLC | Auth |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G20000067346 | PRIVIA MEDICAL GROUP FLORIDA | ACTIVE | 2020-06-15 | 2025-12-31 | No data | 6450 US HIGHWAY 1, ], ROCKLEDGE, FL, 32955 |
| G19000085539 | PRIVIA MEDICAL GROUP CENTRAL FLORIDA | ACTIVE | 2019-08-13 | 2029-12-31 | No data | 6450 US HIGHWAY 1, ROCKLEDGE, FL, 32955 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2020-06-15 | 6450 US HIGHWAY 1, ROCKLEDGE, FL 32955 | No data |
| CHANGE OF MAILING ADDRESS | 2020-06-15 | 6450 US HIGHWAY 1, ROCKLEDGE, FL 32955 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-06-15 | 6450 US Highway 1, Rockledge, FL 32955 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-23 |
| ANNUAL REPORT | 2023-03-28 |
| ANNUAL REPORT | 2022-03-08 |
| ANNUAL REPORT | 2021-03-02 |
| ANNUAL REPORT | 2020-06-15 |
| Florida Limited Liability | 2019-01-29 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
