| Entity Name: | PCP SPECIALISTS OF THE PALM BEACHES, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Inactive |
| Date Filed: | 22 Feb 2019 (6 years ago) |
| Date of dissolution: | 25 Sep 2020 (4 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 25 Sep 2020 (4 years ago) |
| Document Number: | L19000052742 |
| Address: | 5700 LAKE WORTH ROAD, SUITE 204, LAKE WORTH, FL 33463 UN |
| Mail Address: | 5700 LAKE WORTH ROAD, SUITE 204, LAKE WORTH, FL 33463 UN |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1225591084 | 2019-04-09 | 2019-04-09 | 5700 LAKE WORTH RD STE 204, GREENACRES, FL, 334633213, US | 5401 S CONGRESS AVE STE 218, LAKE WORTH, FL, 334626337, US | |||||||||||||||||||
|
|||||||||||||||||||||||
| Phone | +1 561-966-7707 |
| Fax | 8883162198 |
| Phone | +1 561-968-3806 |
| Fax | 5619687673 |
Authorized person
| Name | CASEY WATERS |
| Role | COO |
| Phone | 5619667702 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| WATERS, CASEY | Agent | 5700 LAKE WORTH ROAD, SUITE 204, LAKE WORTH, FL 33463 |
| Name | Role | Address |
|---|---|---|
| HERON, JAMES | Manager | 5700 LAKE WORTH ROAD, SUITE 204, LAKE WORTH, FL 33463 |
| Name | Role | Address |
|---|---|---|
| WATERS, CASEY | Authorized Representative | 5700 LAKE WORTH ROAD, SUITE 204, LAKE WORTH, FL 33463 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2020-09-25 | No data | No data |
| Name | Date |
|---|---|
| Florida Limited Liability | 2019-02-22 |
Date of last update: 17 Jan 2025
Sources: Florida Department of State
