| Entity Name: | SAJID KHAN MD LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 10 Sep 2019 (5 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 16 Jan 2024 (a year ago) |
| Document Number: | L19000228831 |
| FEI/EIN Number | 84-3104423 |
| Address: | 916 ROTARY RD, JACKSONVILLE, FL 32211-8400 |
| Mail Address: | 916 ROTARY RD, JACKSONVILLE, FL 32211-8400 |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1689296808 | 2020-05-11 | 2021-09-10 | 4100 SOUTHPOINT DR E STE 1, JACKSONVILLE, FL, 322168710, US | 4100 SOUTHPOINT DR E STE 1, JACKSONVILLE, FL, 322168710, US | |||||||||||||||||||||
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| Phone | +1 904-420-7569 |
| Fax | 8472216792 |
Authorized person
| Name | DR. SAJID KHAN |
| Role | MD |
| Phone | 9044207569 |
Taxonomy
| Taxonomy Code | 208D00000X - General Practice Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 106420200 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| KHAN, SAJID S | Agent | 916 ROTARY RD, JACKSONVILLE, FL 32211-8400 |
| Name | Role | Address |
|---|---|---|
| KHAN, SAJID | Manager | 916 ROTARY RD, JACKSONVILLE, FL 32211-8400 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G21000034738 | JAX CLINICS | ACTIVE | 2021-03-12 | 2026-12-31 | No data | 128 HICKORY CRSE, OCALA, FL, 34472 |
| G21000033981 | FUTURE PHYSICIANS | ACTIVE | 2021-03-10 | 2026-12-31 | No data | 128 HICKORY CRSE, OCALA, FL, 34472 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2024-01-16 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2024-01-16 | 916 ROTARY RD, JACKSONVILLE, FL 32211-8400 | No data |
| CHANGE OF MAILING ADDRESS | 2024-01-16 | 916 ROTARY RD, JACKSONVILLE, FL 32211-8400 | No data |
| REGISTERED AGENT NAME CHANGED | 2024-01-16 | KHAN, SAJID S | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-01-16 | 916 ROTARY RD, JACKSONVILLE, FL 32211-8400 | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2023-09-22 | No data | No data |
| Name | Date |
|---|---|
| REINSTATEMENT | 2024-01-16 |
| ANNUAL REPORT | 2022-01-24 |
| ANNUAL REPORT | 2021-04-08 |
| ANNUAL REPORT | 2020-04-01 |
| Florida Limited Liability | 2019-09-10 |
Date of last update: 16 Jan 2025
Sources: Florida Department of State
