| Entity Name: | MEMORIAL MEDICAL GROUP OF SOUTH FLORIDA, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 29 Jul 2020 (5 years ago) |
| Last Event: | LC STMNT OF RA/RO CHG |
| Event Date Filed: | 28 Sep 2020 (4 years ago) |
| Document Number: | L20000225259 |
| FEI/EIN Number | 852374409 |
| Mail Address: | 16000 PINES BOULEVARD, #822503, PEMBROKE PINES, FL, 33082, US |
| Address: | 15800 Pines Boulevard, STE 325, Pembroke Pines, FL, 33027, US |
| ZIP code: | 33027 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1336806801 | 2021-11-19 | 2021-11-19 | 16000 PINES BOULEVARD, #822503, PEMBROKE PINES, FL, 330822503, US | 4000 HOLLYWOOD BLVD STE 555S, HOLLYWOOD, FL, 330216853, US | |||||||||||||||||
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| Phone | +1 754-273-0885 |
| Fax | 7542407841 |
| Fax | 8339553596 |
Authorized person
| Name | MS. LISA B MARSHALL |
| Role | MEDICAL DIRECTOR |
| Phone | 7542730885 |
Taxonomy
| Taxonomy Code | 363A00000X - Physician Assistant |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| MARSHALL LISA B | Agent | 15800 Pines Boulevard, Pembroke Pines, FL, 33027 |
| Name | Role | Address |
|---|---|---|
| Marshall Lisa | Medi | 15800 Pines Boulevard, Pembroke Pines, FL, 33027 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G20000099757 | MEMORIAL MENTAL HEALTH OF SOUTH FLORIDA, LLC | ACTIVE | 2020-08-06 | 2025-12-31 | No data | 16000 PINES BOULEVARD, #822503, PEMBROKE PINES, FL, 33082 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-01-12 | 15800 Pines Boulevard, STE 325, Pembroke Pines, FL 33027 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-01-12 | 15800 Pines Boulevard, STE 325, Pembroke Pines, FL 33027 | No data |
| LC STMNT OF RA/RO CHG | 2020-09-28 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-12 |
| ANNUAL REPORT | 2023-01-23 |
| ANNUAL REPORT | 2022-01-24 |
| ANNUAL REPORT | 2021-01-27 |
| CORLCRACHG | 2020-09-28 |
| Florida Limited Liability | 2020-07-29 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
