| Entity Name: | LAKE HOWELL FAMILY MEDICINE ASSOCIATES, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 03 Nov 2020 (4 years ago) |
| Document Number: | L20000349914 |
| FEI/EIN Number | 59-2138140 |
| Address: | 590 RUBY CT, MAITLAND, FL 32751 |
| Mail Address: | 590 RUBY CT, MAITLAND, FL 32751 |
| ZIP code: | 32751 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1497713390 | 2006-05-02 | 2020-10-15 | 590 RUBY CT, MAITLAND, FL, 327515226, US | 590 RUBY CT, MAITLAND, FL, 327515226, US | |||||||||||||||||||||||||||||||
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| Phone | +1 407-677-4867 |
| Fax | 4076774203 |
Authorized person
| Name | DR. WILLIAM MARK SILVERMAN |
| Role | PHYSICIAN OWNER |
| Phone | 4076774867 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | OS0003966 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 373802700 |
| State | FL |
| Issuer | BCBS |
| Number | 33370 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SILVERMAN, JENNIFER | Agent | 590 RUBY CT, MAITLAND, FL 32751 |
| Name | Role | Address |
|---|---|---|
| SILVERMAN, WILLIAM | Authorized Member | 1248 WELLINGTON TERR, MAITLAND, FL 32751 |
| SILVERMAN, DOROTHY | Authorized Member | 1248 WELLINGTON TERR, MAITLAND, FL 32751 |
| SILVERMAN, JENNIFER | Authorized Member | 115 LAMPLIGHTER RD, ALTAMONTE SPRINGS, FL 32714 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CONVERSION | 2020-11-03 | No data | CORPORATION WAS A CONVERSION RESULT. CONVERTING CORPORATION WAS F56130. CONVERSION NUMBER 300000214163 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-08 |
| ANNUAL REPORT | 2023-04-15 |
| ANNUAL REPORT | 2022-04-22 |
| ANNUAL REPORT | 2021-03-29 |
| Florida Limited Liability | 2020-11-03 |
Date of last update: 15 Jan 2025
Sources: Florida Department of State
