| Entity Name: | MEDEK PROVIDER NETWORK LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 05 Jun 2020 (5 years ago) |
| Document Number: | L20000149688 |
| FEI/EIN Number | 85-1337128 |
| Address: | 131 WATERMAN AVE., MOUNT DORA, FL, 32757 |
| Mail Address: | 131 WATERMAN AVE., MOUNT DORA, FL, 32757 |
| ZIP code: | 32757 |
| County: | Lake |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1356959779 | 2020-07-22 | 2021-07-06 | 131 WATERMAN AVE, MOUNT DORA, FL, 327579541, US | 131 WATERMAN AVE, MOUNT DORA, FL, 327579541, US | |||||||||||||
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| Phone | +1 352-385-1803 |
Authorized person
| Name | EUGENE MAHFOOD |
| Role | DIRECTOR OF OPERATIONS |
| Phone | 9548923940 |
Taxonomy
| Taxonomy Code | 208D00000X - General Practice Physician |
| Is Primary | Yes |
| Name | Role |
|---|---|
| SPIEGEL & UTRERA, P.A. | Agent |
| Name | Role | Address |
|---|---|---|
| METER STAN V | Manager | 131 WATERMAN AVE., MOUNT DORA, FL, 32757 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-19 |
| ANNUAL REPORT | 2023-03-17 |
| ANNUAL REPORT | 2022-04-12 |
| ANNUAL REPORT | 2021-04-12 |
| Florida Limited Liability | 2020-06-05 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
