| Entity Name: | MEDEC MEDICAL CARE PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 17 Nov 2020 (4 years ago) |
| Document Number: | L20000363133 |
| FEI/EIN Number | 85-3911612 |
| Address: | 1270 N Wickham Rd Ste 9 & 10, Melbourne, FL, 32935, US |
| Mail Address: | 1270 N Wickham Rd Ste 9 & 10, Melbourne, FL, 32935, US |
| ZIP code: | 32935 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1386234268 | 2021-01-25 | 2024-07-26 | 1270 N WICKHAM RD STE 9, MELBOURNE, FL, 329358300, US | 1270 N WICKHAM RD STE 9, MELBOURNE, FL, 329358300, US | |||||||||||||||||||||||||||
|
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| Phone | +1 321-567-2211 |
| Fax | 3212860496 |
Authorized person
| Name | QAZIM SALIA |
| Role | OWNER |
| Phone | 3127192211 |
Taxonomy
| Taxonomy Code | 261Q00000X - Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | FL BCBS |
| Number | E8X1N |
| State | FL |
| Issuer | MEDICAID |
| Number | 110804600 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SALIA QAZIM | Agent | 600 GARDEN ST, TITUSVILLE, FL, 32796 |
| Name | Role | Address |
|---|---|---|
| SALIA QAZIM | Authorized Member | 1270 N Wickham Rd Ste 9 & 10, Melbourne, FL, 32935 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G24000089278 | EXPRESS Q AESTHETICS | ACTIVE | 2024-07-25 | 2029-12-31 | No data | 600 GARDEN STREET, TITUSVILLE, FL, 32796 |
| G24000089321 | Q AESTHETICS | ACTIVE | 2024-07-25 | 2029-12-31 | No data | 1270 N WICKHAM ROAD/STE 10, MELBOURNE, FL, 32935 |
| G24000053639 | EXPRESS CARE MELBOURNE | ACTIVE | 2024-04-22 | 2029-12-31 | No data | 1270 N WICKHAM ROAD/STE 10, MELBOURNE, FL, 32935 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-09-19 | 1270 N Wickham Rd Ste 9 & 10, Melbourne, FL 32935 | No data |
| CHANGE OF MAILING ADDRESS | 2024-09-19 | 1270 N Wickham Rd Ste 9 & 10, Melbourne, FL 32935 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-01-20 | 600 GARDEN ST, TITUSVILLE, FL 32796 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-27 |
| ANNUAL REPORT | 2023-01-20 |
| ANNUAL REPORT | 2022-03-15 |
| ANNUAL REPORT | 2021-04-12 |
| Florida Limited Liability | 2020-11-17 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
