| Entity Name: | URGENT CARE CENTERS OF BREVARD COUNTY, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 08 Jan 2020 (5 years ago) |
| Document Number: | L20000005538 |
| FEI/EIN Number | 84-4261523 |
| Address: | 2600 WESTHALL LN, MAITLAND, FL 32751 |
| Mail Address: | 2600 WESTHALL LN, MAITLAND, FL 32751 |
| ZIP code: | 32751 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1801594858 | 2023-02-20 | 2023-04-18 | 2600 WESTHALL LN STE 300, MAITLAND, FL, 327517107, US | 6345 N. WICKHAM ROAD, SUITE 101, MELBOURNE, FL, 32940, US | |||||||||||||||||||||||||||||||||||||||
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| Phone | +1 407-200-2300 |
| Phone | +1 321-757-2464 |
| Fax | 3217572465 |
Authorized person
| Name | SCOTT C BRADY |
| Role | PRESIDENT |
| Phone | 4072002300 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 208000000X - Pediatrics Physician |
| Is Primary | No |
| Taxonomy Code | 261QU0200X - Urgent Care Clinic/Center |
| Is Primary | Yes |
| Taxonomy Code | 363A00000X - Physician Assistant |
| Is Primary | No |
| Taxonomy Code | 363LF0000X - Family Nurse Practitioner |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICARE |
| Number | MQ224 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BROMME, JEFF | Agent | 900 HOPE WAY, ALTAMONTE SPRINGS, FL 32714 |
| Name | Role | Address |
|---|---|---|
| PASWATERS, ROBERT | Manager | 2600 WESTHALL LN, MAITLAND, FL 32751 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G23000030811 | HEALTH FIRST ADVENTHEALTH CENTRA CARE MELBOURNE | ACTIVE | 2023-03-07 | 2028-12-31 | No data | 6345 NORTH WICKHAM RD, SUITE 101, MELBOURNE, FL, 32940 |
| G20000032053 | HEALTH FIRST ADVENTHEALTH CENTRA CARE COCOA BEACH | ACTIVE | 2020-03-13 | 2025-12-31 | No data | 105 SOUTH BANANA RIVERA BLVD., UNIT SBPP, COCOA BEACH, FL, 32931 |
| G20000032054 | HEALTH FIRST ADVENTHEALTH CENTRA CARE GATEWAY | ACTIVE | 2020-03-13 | 2025-12-31 | No data | 1223 GATEWAY DRIVE, SUITE 1E, MELBOURNE, FL, 32901 |
| G20000032055 | HEALTH FIRST ADVENTHEALTH CENTRA CARE MALABAR | ACTIVE | 2020-03-13 | 2025-12-31 | No data | 730 MALABAR ROAD NE, SUITE B, MALABAR, FL, 32905 |
| G20000032060 | HEALTH FIRST ADVENTHEALTH CENTRA CARE | ACTIVE | 2020-03-13 | 2025-12-31 | No data | 2600 WESTHALL LANE, MAITLAND, FL, 32751 |
| G20000023548 | ADVENTHEALTH CENTRA CARE TITUSVILLE | ACTIVE | 2020-02-22 | 2025-12-31 | No data | 603 NORTH WASHINGTON AVE., SUITE 101, TITUSVILLE, FL, 32796 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-25 |
| ANNUAL REPORT | 2023-01-25 |
| ANNUAL REPORT | 2022-05-02 |
| ANNUAL REPORT | 2021-04-06 |
| Florida Limited Liability | 2020-01-08 |
Date of last update: 16 Jan 2025
Sources: Florida Department of State
