| Entity Name: | AIR BASE MEDICAL CENTER LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 18 Jun 2020 (5 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 18 Oct 2021 (3 years ago) |
| Document Number: | L20000169271 |
| FEI/EIN Number | 85-1589103 |
| Address: | 12803 SW 280 ST, HOMESTEAD, FL, 33032, US |
| Mail Address: | 20753 SW 128TH CT, MIAMI, FL, 33177, US |
| ZIP code: | 33032 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1588336051 | 2021-10-01 | 2022-10-18 | 20753 SW 128TH CT, MIAMI, FL, 331775518, US | 12803 SW 280TH ST, HOMESTEAD, FL, 330328552, US | |||||||||||||||||||||
|
|||||||||||||||||||||||||
| Phone | +1 305-342-4083 |
| Fax | 7865043092 |
| Phone | +1 786-504-3022 |
Authorized person
| Name | DR. CARMEN MORALES |
| Role | MGR |
| Phone | 7865043022 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| RIVERA ARMANDO | Agent | 12803 SW 280 ST, MIAMI, FL, 33032 |
| Name | Role | Address |
|---|---|---|
| RIVERA ARMANDO | Manager | 12803 SW 280 ST, HOMESTEAD, FL, 33032 |
| MORALES CARMEN | Manager | 12803 SW 280 ST, HOMESTEAD, FL, 33032 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC AMENDMENT | 2021-10-18 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-10-18 | 12803 SW 280 ST, MIAMI, FL 33032 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2021-04-05 | 12803 SW 280 ST, HOMESTEAD, FL 33032 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-03 |
| ANNUAL REPORT | 2023-03-06 |
| ANNUAL REPORT | 2022-01-24 |
| LC Amendment | 2021-10-18 |
| ANNUAL REPORT | 2021-04-05 |
| Florida Limited Liability | 2020-06-18 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
