| Entity Name: | SOUTHEAST UNIVERSITY PHYSICIANS PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 06 Feb 2019 (6 years ago) |
| Document Number: | L19000038063 |
| FEI/EIN Number | 83-3636368 |
| Address: | 2560 RCA Boulevard, SUITE 106, PALM BEACH GARDENS, FL 33410 |
| Mail Address: | 2560 RCA Boulevard, SUITE 106, PALM BEACH GARDENS, FL 33410 |
| ZIP code: | 33410 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1710444583 | 2019-02-27 | 2024-07-22 | 2560 RCA BLVD STE 106, PALM BEACH GARDENS, FL, 334103336, US | 2560 RCA BLVD STE 106, PALM BEACH GARDENS, FL, 334103336, US | |||||||||||||||||||||||
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| Phone | +1 561-799-9559 |
| Fax | 5617999577 |
Authorized person
| Name | KATHRYN NOLAND |
| Role | PRACTICE MANAGER |
| Phone | 5617999559 |
Taxonomy
| Taxonomy Code | 207RC0200X - Critical Care Medicine (Internal Medicine) Physician |
| Is Primary | No |
| Taxonomy Code | 208600000X - Surgery Physician |
| Is Primary | No |
| Taxonomy Code | 2086S0102X - Surgical Critical Care Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| WEBB MILLSPS LAW FIRM, PA | Agent | 160 W CAMINO REAL 190, BOCA RATON, FL 33432 |
| Name | Role | Address |
|---|---|---|
| BORREGO, ROBERT | Manager | 3375 BURNS ROAD, PALM BEACH GARDENS, FL 33410 |
| Ramseyer, Matthew | Manager | 3375 BURNS ROAD, 206 PALM BEACH GARDENS, FL 33410 |
| Name | Role | Address |
|---|---|---|
| Azar, Faris | MANAGER | 3375 BURNS ROAD, 206 PALM BEACH GARDENS, FL 33410 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2022-12-12 | 2560 RCA Boulevard, SUITE 106, PALM BEACH GARDENS, FL 33410 | No data |
| CHANGE OF MAILING ADDRESS | 2022-12-12 | 2560 RCA Boulevard, SUITE 106, PALM BEACH GARDENS, FL 33410 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-09 |
| ANNUAL REPORT | 2023-03-31 |
| ANNUAL REPORT | 2022-03-28 |
| ANNUAL REPORT | 2021-04-20 |
| ANNUAL REPORT | 2020-01-21 |
| Florida Limited Liability | 2019-02-06 |
Date of last update: 16 Feb 2025
Sources: Florida Department of State
