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SPACE COAST MEDICAL MANAGEMENT, LLC - Florida Company Profile

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Company Details

Entity Name: SPACE COAST MEDICAL MANAGEMENT, LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Active
Date Filed: 19 Oct 2020 (5 years ago)
Document Number: L20000329992
FEI/EIN Number 85-3658429
Address: 14698 Erice Avenue, Clermont, FL, 34714, US
Mail Address: 14698 Erice Avenue, Clermont, FL, 34714, US
ZIP code: 34714
City: Clermont
County: Lake
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
HUSTED MAUREEN Manager 14698 Erice Avenue, Clermont, FL, 34714
HUSTED MAUREEN Agent 14698 Erice Avenue, Clermont, FL, 34714
Husted Michael Auth 14698 Erice Avenue, Clermont, FL, 34714

National Provider Identifier

NPI Number:
1881298768
Certification Date:
2020-11-23

Authorized Person:

Name:
MICHAEL HUSTED
Role:
CFO
Phone:

Taxonomy:

Selected Taxonomy:
261QP2300X - Primary Care Clinic/Center
Is Primary:
Yes

Contacts:

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2024-04-02 27749 Quail View Lane, Wesley Chapel, FL 33544 -
CHANGE OF MAILING ADDRESS 2024-04-02 27749 Quail View Lane, Wesley Chapel, FL 33544 -
REGISTERED AGENT ADDRESS CHANGED 2024-04-02 27749 Quail View Lane, Wesley Chapel, FL 33544 -
REGISTERED AGENT NAME CHANGED 2022-04-28 HUSTED, MAUREEN -

Documents

Name Date
ANNUAL REPORT 2024-04-02
ANNUAL REPORT 2023-04-06
AMENDED ANNUAL REPORT 2022-04-28
ANNUAL REPORT 2022-01-30
ANNUAL REPORT 2021-03-26
Florida Limited Liability 2020-10-19

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Date of last update: 01 Aug 2025

Sources: Florida Department of State