| Entity Name: | ALLIANCE OBSTETRICS & GYNECOLOGY GROUP, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 28 Aug 2019 (5 years ago) |
| Document Number: | L19000219854 |
| FEI/EIN Number | 842884354 |
| Address: | 2289 Glenwood Drive, WINTER PARK, FL, 32792, US |
| Mail Address: | 2289 Glenwood Drive, WINTER PARK, FL, 32792, US |
| ZIP code: | 32792 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1841841830 | 2019-09-23 | 2022-03-01 | 3300 S FISKE BLVD, ROCKLEDGE, FL, 329554306, US | 2035 GLENWOOD DR, WINTER PARK, FL, 327923307, US | |||||||||||||||||||||||||||||||
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| Phone | +1 407-960-2112 |
| Fax | 4079607024 |
Authorized person
| Name | AMEIGH VERDEROSA WORLEY |
| Role | OWNER/PHYSICIAN |
| Phone | 3217941864 |
Taxonomy
| Taxonomy Code | 207V00000X - Obstetrics & Gynecology Physician |
| Is Primary | Yes |
| Taxonomy Code | 2080A0000X - Pediatric Adolescent Medicine Physician |
| Is Primary | No |
Other Provider Identifiers
| Issuer | FL MEDICARE |
| Number | NP414 |
| State | FL |
| Issuer | MEDICAID |
| Number | PENDING |
| State | FL |
| Name | Role | Address |
|---|---|---|
| WORLEY AMEIGH V | Agent | 2289 Glenwood Drive, WINTER PARK, FL, 32792 |
| Name | Role | Address |
|---|---|---|
| WORLEY AMEIGH V | Manager | 2289 Glenwood Drive, WINTER PARK, FL, 32792 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G21000039693 | CENTER FOR PEDIATRIC & ADOLESCENT GYNECOLOGY | ACTIVE | 2021-03-22 | 2026-12-31 | No data | 2035 GLENWOOD DRIVE, WINTER PARK, FL, 32792 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-06-01 | 2289 Glenwood Drive, WINTER PARK, FL 32792 | No data |
| CHANGE OF MAILING ADDRESS | 2023-06-01 | 2289 Glenwood Drive, WINTER PARK, FL 32792 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-06-01 | 2289 Glenwood Drive, WINTER PARK, FL 32792 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-12 |
| AMENDED ANNUAL REPORT | 2023-06-01 |
| ANNUAL REPORT | 2023-02-19 |
| ANNUAL REPORT | 2022-01-31 |
| ANNUAL REPORT | 2021-02-07 |
| ANNUAL REPORT | 2020-01-26 |
| Florida Limited Liability | 2019-08-28 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
