| Entity Name: | SPACE COAST MEDICAL MANAGEMENT, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 19 Oct 2020 (4 years ago) |
| Document Number: | L20000329992 |
| FEI/EIN Number | 85-3658429 |
| Address: | 27749 Quail View Lane, Wesley Chapel, FL, 33544, US |
| Mail Address: | 27749 Quail View Lane, Wesley Chapel, FL, 33544, US |
| ZIP code: | 33544 |
| County: | Pasco |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1881298768 | 2020-11-23 | 2020-11-23 | 1840 ELDRON BLVD SE STE 2, PALM BAY, FL, 329096871, US | 1840 ELDRON BLVD SE STE 2, PALM BAY, FL, 329096871, US | |||||||||||||
|
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| Phone | +1 561-523-3973 |
Authorized person
| Name | MICHAEL HUSTED |
| Role | CFO |
| Phone | 5615233973 |
Taxonomy
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| HUSTED MAUREEN | Agent | 27749 Quail View Lane, Wesley Chapel, FL, 33544 |
| Name | Role | Address |
|---|---|---|
| HUSTED MAUREEN | Manager | 27749 Quail View Lane, Wesley Chapel, FL, 33544 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-04-02 | 27749 Quail View Lane, Wesley Chapel, FL 33544 | No data |
| CHANGE OF MAILING ADDRESS | 2024-04-02 | 27749 Quail View Lane, Wesley Chapel, FL 33544 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-04-02 | 27749 Quail View Lane, Wesley Chapel, FL 33544 | No data |
| REGISTERED AGENT NAME CHANGED | 2022-04-28 | HUSTED, MAUREEN | No data |
| 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 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
