| Entity Name: | FLORIDA INTERVENTIONAL PROVIDERS LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 12 Aug 2019 (5 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 26 Nov 2021 (3 years ago) |
| Document Number: | L19000204877 |
| FEI/EIN Number | 84-2780894 |
| Address: | 2202 SE 23RD RD, HOMESTEAD, FL, 33035 |
| Mail Address: | 2202 SE 23RD RD, HOMESTEAD, FL, 33035 |
| ZIP code: | 33035 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1477134658 | 2021-04-19 | 2021-04-19 | 2202 SE 23RD RD, HOMESTEAD, FL, 330351904, US | 2202 SE 23RD RD, HOMESTEAD, FL, 330351904, US | |||||||||||||||||||||||
|
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| Phone | +1 201-951-3113 |
| Fax | 3056753346 |
Authorized person
| Name | MR. DARRELL JOHNSON |
| Role | ADMINISTRATOR |
| Phone | 5613566313 |
Taxonomy
| Taxonomy Code | 207QA0401X - Addiction Medicine (Family Medicine) Physician |
| Is Primary | Yes |
| Taxonomy Code | 207QS0010X - Sports Medicine (Family Medicine) Physician |
| Is Primary | No |
| Taxonomy Code | 207RC0000X - Cardiovascular Disease Physician |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| SALINAS ROBERT | Agent | 19452 NE 26th Ave, Miami, FL, 33180 |
| Name | Role | Address |
|---|---|---|
| IBRAHEIM GEORGE | Authorized Member | 2202 SE 23RD RD, HOMESTEAD, FL, 33035 |
| EWING TAMMY | Authorized Member | 730 SW 7TH ST APT 1, HALLANDALE BEACH, FL, 33009 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2021-11-26 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2021-11-26 | SALINAS, ROBERT | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2021-09-24 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-06-30 | 19452 NE 26th Ave, Apt 32C, Miami, FL 33180 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-14 |
| ANNUAL REPORT | 2023-04-30 |
| ANNUAL REPORT | 2022-04-30 |
| REINSTATEMENT | 2021-11-26 |
| ANNUAL REPORT | 2020-06-30 |
| Florida Limited Liability | 2019-08-12 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
