| Entity Name: | ACCESS MEDICAL GROUP OF LAKELAND, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 12 Sep 2019 (5 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 05 Oct 2020 (4 years ago) |
| Document Number: | L19000231219 |
| FEI/EIN Number | 84-2750188 |
| Address: | 6100 Blue Lagoon Dr., Miami, FL 33126 |
| Mail Address: | 7700 Forsyth Blvd., St. Louis, MO 63105 |
| ZIP code: | 33126 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1396391033 | 2019-08-16 | 2023-05-25 | 6100 BLUE LAGOON DR STE 365, MIAMI, FL, 331267010, US | 5615 S FLORIDA AVE STE 111, LAKELAND, FL, 338132714, US | |||||||||||||||||||||||||
|
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| Phone | +1 786-208-3237 |
| Fax | 7863227329 |
| Phone | +1 863-327-0132 |
| Fax | 8637772320 |
Authorized person
| Name | MR. RAYNY RAMIREZ |
| Role | PRESIDENT |
| Phone | 7863227333 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 106341600 |
| State | FL |
| Name | Role |
|---|---|
| C T CORPORATION SYSTEM | Agent |
| Name | Role | Address |
|---|---|---|
| Chervitz, Chuck | Manager | 7700 Forsyth Blvd., St. Louis, MO 63105 |
| Name | Role | Address |
|---|---|---|
| Koster, Christopher A | Secretary | 7700 Forsyth Blvd., St. Louis, MO 63105 |
| Name | Role | Address |
|---|---|---|
| Dinkelman, Tricia | Vice President | 7700 Forsyth Blvd., St. Louis, MO 63105 |
| Baiocchi, Sarah | Vice President | 7700 Forsyth Blvd., St. Louis, MO 63105 |
| Majors, Richard | Vice President | 6100 Blue Lagoon Dr., Miami, FL 33126 |
| Name | Role | Address |
|---|---|---|
| Dinkelman, Tricia | Tax | 7700 Forsyth Blvd., St. Louis, MO 63105 |
| Name | Role | Address |
|---|---|---|
| Ramirez, Rayny | President | 6100 Blue Lagoon Dr., Miami, FL 33126 |
| Name | Role | Address |
|---|---|---|
| Majors, Richard | Finance | 6100 Blue Lagoon Dr., Miami, FL 33126 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G19000120420 | COMMUNITY MEDICAL GROUP | EXPIRED | 2019-11-08 | 2024-12-31 | No data | 6100 BLUE LAGOON DR, SUITE 365, MIAMI, FL, 33126 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2021-04-26 | 6100 Blue Lagoon Dr., Miami, FL 33126 | No data |
| CHANGE OF MAILING ADDRESS | 2021-04-26 | 6100 Blue Lagoon Dr., Miami, FL 33126 | No data |
| LC AMENDMENT | 2020-10-05 | No data | No data |
| LC AMENDMENT | 2020-02-28 | No data | No data |
| LC AMENDMENT | 2019-12-04 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-29 |
| AMENDED ANNUAL REPORT | 2023-05-23 |
| ANNUAL REPORT | 2023-05-01 |
| ANNUAL REPORT | 2022-02-07 |
| ANNUAL REPORT | 2021-04-26 |
| LC Amendment | 2020-10-05 |
| ANNUAL REPORT | 2020-04-30 |
| LC Amendment | 2020-02-28 |
| LC Amendment | 2019-12-04 |
| Florida Limited Liability | 2019-09-12 |
Date of last update: 16 Jan 2025
Sources: Florida Department of State
