| Entity Name: | HEART, VASCULAR, AND VEIN OF TAMPA BAY, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 20 May 2020 (5 years ago) |
| Document Number: | L20000133009 |
| FEI/EIN Number | 85-1187937 |
| Address: | 76 MARTINIQUE AVE., TAMPA, FL 33606 |
| Mail Address: | 76 MARTINIQUE AVE., TAMPA, FL 33606 |
| ZIP code: | 33606 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1518580307 | 2020-05-27 | 2020-07-08 | PO BOX 1910, BRANDON, FL, 335091910, US | 621 W LUMSDEN RD, BRANDON, FL, 335115911, US | |||||||||||||||||||||||
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| Phone | +1 813-755-3500 |
| Fax | 8137553300 |
| Phone | +1 813-755-4500 |
Authorized person
| Name | DR. HOSHEDAR TAMBOLI |
| Role | PRESIDENT |
| Phone | 8137553500 |
Taxonomy
| Taxonomy Code | 207RC0000X - Cardiovascular Disease Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 373330100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MCINTYRE, RICHARD J | Agent | 500 EAST KENNEDY BLVD., SUITE 200, TAMPA, FL 33602 |
| Name | Role | Address |
|---|---|---|
| TAMBOLI, HOSHEDAR | Authorized Person | 76 MARTINIQUE AVE., TAMPA, FL 33606 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-29 |
| ANNUAL REPORT | 2023-01-30 |
| ANNUAL REPORT | 2022-01-31 |
| ANNUAL REPORT | 2021-01-30 |
| Florida Limited Liability | 2020-05-20 |
Date of last update: 15 Jan 2025
Sources: Florida Department of State
