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NICKLAUS CHILDREN'S PEDIATRIC SPECIALISTS, LLC

Company Details

Entity Name: NICKLAUS CHILDREN'S PEDIATRIC SPECIALISTS, LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Active
Date Filed: 30 Dec 2020 (4 years ago)
Last Event: CONVERSION
Event Date Filed: 30 Dec 2020 (4 years ago)
Document Number: L20000396769
FEI/EIN Number 463756071
Address: 3100 SW 62ND AVE, MIAMI, FL, 33155, US
Mail Address: 3100 SW 62ND AVE, MIAMI, FL, 33155, US
ZIP code: 33155
County: Miami-Dade
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1912720186 2024-11-05 2024-11-05 PO BOX 947095, ATLANTA, GA, 303947095, US 10230 W STATE ROAD 84, DAVIE, FL, 333244202, US

Contacts

Phone +1 305-666-6511

Authorized person

Name MARCOS MESTRE
Role SVP
Phone 3056666511

Taxonomy

Taxonomy Code 207XP3100X - Pediatric Orthopaedic Surgery Physician
Is Primary No
Taxonomy Code 207XX0005X - Sports Medicine (Orthopaedic Surgery) Physician
Is Primary No
Taxonomy Code 207YP0228X - Pediatric Otolaryngology Physician
Is Primary No
Taxonomy Code 2080P0202X - Pediatric Cardiology Physician
Is Primary Yes
Taxonomy Code 2080P0206X - Pediatric Gastroenterology Physician
Is Primary No
Taxonomy Code 208200000X - Plastic Surgery Physician
Is Primary No
Taxonomy Code 2084N0400X - Neurology Physician
Is Primary No
Taxonomy Code 2084N0402X - Neurology with Special Qualifications in Child Neurology Physician
Is Primary No
Taxonomy Code 261QM1300X - Multi-Specialty Clinic/Center
Is Primary No

Agent

Name Role
MIAMI CHILDREN'S HEALTH SYSTEM, INC. Agent

Member

Name Role Address
MIAMI CHILDREN'S HEALTH SYSTEM, INC DBA NI Member 3100 SW 62ND AVE, MIAMI, FL, 33155

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G24000129380 NICKLAUS CHILDREN'S AT PALM BEACH GARDENS ACTIVE 2024-10-21 2029-12-31 No data 11310 LEGACY AVENUE, PALM BEACH GARDENS, FL, 33410
G24000129354 NICKLAUS CHILDREN'S AT NAPLES ACTIVE 2024-10-21 2029-12-31 No data 3227 HORSESHOE DRIVE SOUTH, NAPLES, FL, 34104
G24000124737 NICKLAUS CHILDREN'S AT WESTON ACTIVE 2024-10-07 2029-12-31 No data 2900 SOUTH COMMERCE PARKWAY, WESTON, FL, 33331
G24000084231 NICKLAUS CHILDREN'S AT DAVIE ACTIVE 2024-07-15 2029-12-31 No data 10230 W STATE ROAD 84, DAVIE, FL, 33324
G24000082418 NICKLAUS CHILDREN'S AT SOUTH MIAMI ACTIVE 2024-07-10 2029-12-31 No data 6262 SUNSET DRIVE, MIAMI, FL, 33143
G24000077397 NICKLAUS CHILDREN'S AT WEST PINES ACTIVE 2024-06-25 2029-12-31 No data 18503 PINES BLVD, SUITE 212, PEMBROKE PINES, FL, 33029
G23000076946 NICKLAUS CHILDREN'S AT SUNSET OAKS ACTIVE 2023-06-27 2028-12-31 No data 9260 SW 72ND STREET, BUILDING 6, SUITE 217, MIAMI, FL, 33173
G23000072473 NICKLAUS CHILDREN'S AT OVERTOWN ACTIVE 2023-06-14 2028-12-31 No data 217 NW 15 STREET, MIAMI, FL, 33136
G23000023682 NICKLAUS CHILDREN'S AT COOPER CITY ACTIVE 2023-02-20 2028-12-31 No data 11011 SHERIDAN STREET, SUITE 311, COOPER CITY, FL, 33026
G23000023717 NICKLAUS CHILDREN'S AT CUTLER BAY ACTIVE 2023-02-20 2028-12-31 No data 18557 S. DIXIE HIGHWAY, MIAMI, FL, 33157

Events

Event Type Filed Date Value Description
REGISTERED AGENT NAME CHANGED 2024-04-11 MIAMI CHILDREN'S HEALTH SYSTEM, INC. No data
REGISTERED AGENT ADDRESS CHANGED 2024-04-11 C/O LEGAL DEPT, 3100 SW 62ND AVE, MIAMI, FL 33155 No data
CONVERSION 2020-12-30 No data CORPORATION WAS A CONVERSION RESULT. CONVERTING CORPORATION WAS N12000008352. CONVERSION NUMBER 100000208931

Documents

Name Date
ANNUAL REPORT 2024-04-11
ANNUAL REPORT 2023-02-22
ANNUAL REPORT 2022-04-27
ANNUAL REPORT 2021-04-19
Florida Limited Liability 2020-12-30

Date of last update: 03 Feb 2025

Sources: Florida Department of State