| Entity Name: | WIREGRASS DIRECT PRIMARY CARE, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 20 Aug 2019 (5 years ago) |
| Document Number: | L19000210319 |
| FEI/EIN Number | 84-2722303 |
| Address: | 2236 Green Hedges Way, WESLEY CHAPEL, FL, 33544, US |
| Mail Address: | 2236 Green Hedges Way, WESLEY CHAPEL, FL, 33544, US |
| ZIP code: | 33544 |
| County: | Pasco |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1649827577 | 2019-08-26 | 2022-04-11 | 2236 GREEN HEDGES WAY, WESLEY CHAPEL, FL, 335448189, US | 2236 GREEN HEDGES WAY, WESLEY CHAPEL, FL, 335448189, US | |||||||||||||||||||||||||||||||||||||
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| Phone | +1 813-999-0505 |
| Fax | 8137019450 |
Authorized person
| Name | DENNIS MICHAEL IPOCK |
| Role | MANAGER |
| Phone | 8139990505 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 261QU0200X - Urgent Care Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 332900000X - Non-Pharmacy Dispensing Site |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 105137300 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| IPOCK DENNIS M | Agent | 2236 Green Hedges Way, WESLEY CHAPEL, FL, 33544 |
| Name | Role | Address |
|---|---|---|
| IPOCK DENNIS MAPRN | Manager | 2236 Green Hedges Way, WESLEY CHAPEL, FL, 33544 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G23000015999 | ZOE MEDICAL SPA | ACTIVE | 2023-02-01 | 2028-12-31 | No data | 2236 GREEN HEDGES WAY, WESLEY CHAPEL, FL, 33544 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2022-01-19 | 2236 Green Hedges Way, WESLEY CHAPEL, FL 33544 | No data |
| CHANGE OF MAILING ADDRESS | 2022-01-19 | 2236 Green Hedges Way, WESLEY CHAPEL, FL 33544 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-01-19 | 2236 Green Hedges Way, WESLEY CHAPEL, FL 33544 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-14 |
| ANNUAL REPORT | 2023-01-21 |
| ANNUAL REPORT | 2022-01-19 |
| ANNUAL REPORT | 2021-02-03 |
| ANNUAL REPORT | 2020-01-17 |
| Florida Limited Liability | 2019-08-20 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
