| Entity Name: | MD MEDICAL SERVICES, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 17 Feb 2021 (4 years ago) |
| Document Number: | L21000081831 |
| FEI/EIN Number | 38-4173537 |
| Address: | 5392 BLUE PACIFIC DR W, JACKSONVILLE, FL, 32257, US |
| Mail Address: | 5392 BLUE PACIFIC DR W, JACKSONVILLE, FL, 32257, US |
| ZIP code: | 32257 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1104374677 | 2016-09-14 | 2016-09-14 | 7000 WEST PALMETTO PARK RD STE 205, BOCA RATON, FL, 33433, US | 7000 W PALMETTO PARK RD STE 205, BOCA RATON, FL, 334333430, US | |||||||||||||||||
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| Phone | +1 855-200-8262 |
Authorized person
| Name | RUSSEL PACKARD |
| Role | MEDICAL DOCTOR |
| Phone | 8552008262 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| License Number | ME30779 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| TEA AMIDA | Agent | 5392 BLUE PACIFIC DR., W, JACKSONVILLE, FL, 32257 |
| Name | Role | Address |
|---|---|---|
| BOTOLINO GREGORY J | Manager | 5392 BLUE PACIFIC DR W, JACKSONVILLE, FL, 32257 |
| TEA AMIDA | Manager | 5392 BLUE PACIFIC DR W, JACKSONVILLE, FL, 32257 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-04-08 | 5392 BLUE PACIFIC DR W, JACKSONVILLE, FL 32257 | No data |
| CHANGE OF MAILING ADDRESS | 2024-04-08 | 5392 BLUE PACIFIC DR W, JACKSONVILLE, FL 32257 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-08 |
| ANNUAL REPORT | 2023-04-26 |
| ANNUAL REPORT | 2022-03-18 |
| Florida Limited Liability | 2021-02-17 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
