| Entity Name: | AVON PARK MEDICAL GROUP, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 11 Jun 2020 (5 years ago) |
| Document Number: | L20000161561 |
| FEI/EIN Number | APPLIED FOR |
| Mail Address: | 5901 WEBB ROAD, TAMPA, FL 33615 |
| Address: | 1023 US Hwy 27 S, Avon Park, FL 33825 |
| ZIP code: | 33825 |
| County: | Highlands |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1225641954 | 2020-08-24 | 2020-08-24 | 5901 WEBB RD, TAMPA, FL, 336153219, US | 1023 US HIGHWAY 27 S, AVON PARK, FL, 338255107, US | |||||||||||||||
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| Phone | +1 813-888-8215 |
| Fax | 8138855398 |
Authorized person
| Name | MR. ANTONIO CALVO JR. |
| Role | COO |
| Phone | 8139995309 |
Taxonomy
| Taxonomy Code | 261Q00000X - Clinic/Center |
| Is Primary | Yes |
| Name | Role |
|---|---|
| BUBLEY & BUBLEY, P.A. | Agent |
| Name | Role | Address |
|---|---|---|
| REVELLO, PATRICIA | Authorized Member | 5901 WEBB ROAD, TAMPA, FL 33615 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2022-02-15 | 1023 US Hwy 27 S, Avon Park, FL 33825 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-06 |
| ANNUAL REPORT | 2023-01-25 |
| ANNUAL REPORT | 2022-02-15 |
| ANNUAL REPORT | 2021-02-15 |
| Florida Limited Liability | 2020-06-11 |
Date of last update: 15 Jan 2025
Sources: Florida Department of State
