| Entity Name: | LEGACY ORTHOPAEDICS LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 12 May 2020 (5 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 03 Nov 2021 (3 years ago) |
| Document Number: | L20000127759 |
| FEI/EIN Number | 85-1483059 |
| Mail Address: | 7000 SW 62nd Ave, South Miami, FL, 33143, US |
| Address: | 7000 SW 62nd Avenue, South Miami, FL, 33143, US |
| ZIP code: | 33143 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1942801600 | 2020-11-07 | 2023-05-12 | 650 NE 32ND ST UNIT 3003, MIAMI, FL, 331375260, US | 7000 SW 62ND AVE STE 330, SOUTH MIAMI, FL, 331434717, US | |||||||||||||||||||||||
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| Phone | +1 215-919-0419 |
| Fax | 2153304808 |
| Phone | +1 786-238-7402 |
Authorized person
| Name | DR. THOMAS D. RILEY IV |
| Role | CEO/PHYSICIAN |
| Phone | 7868456645 |
Taxonomy
| Taxonomy Code | 207X00000X - Orthopaedic Surgery Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 117862500 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Thomas Riley | Agent | 650 NE 32nd Street, Miami, FL, 33137 |
| Name | Role | Address |
|---|---|---|
| RILEY THOMAS | Chief Executive Officer | 650 NE 32nd Street, Miami, FL, 33137 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-02-06 | 7000 SW 62nd Avenue, Suite 330, South Miami, FL 33143 | No data |
| CHANGE OF MAILING ADDRESS | 2024-02-06 | 7000 SW 62nd Avenue, Suite 330, South Miami, FL 33143 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-02-06 | 650 NE 32nd Street, Unit #3003, Miami, FL 33137 | No data |
| REGISTERED AGENT NAME CHANGED | 2023-01-27 | Thomas, Riley | No data |
| REINSTATEMENT | 2021-11-03 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2021-09-24 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-06 |
| AMENDED ANNUAL REPORT | 2023-04-05 |
| ANNUAL REPORT | 2023-01-27 |
| ANNUAL REPORT | 2022-04-12 |
| REINSTATEMENT | 2021-11-03 |
| Florida Limited Liability | 2020-05-12 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
