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MISSION FAMILY MEDICINE LLC - Florida Company Profile

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Company Details

Entity Name: MISSION FAMILY MEDICINE LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Active
Date Filed: 22 Mar 2021 (4 years ago)
Document Number: L21000132107
FEI/EIN Number 86-3013918
Address: 1785 GARDEN STREET, TITUSVILLE, FL, 32796
Mail Address: 1785 GARDEN STREET, TITUSVILLE, FL, 32796
ZIP code: 32796
City: Titusville
County: Brevard
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
MARSHALL BENJAMIN G Authorized Representative 1733 CASTLE DRIVE, TITUSVILLE, FL, 32796
MARSHALL MIRANDA B Authorized Representative 1733 CASTLE DRIVE, TITUSVILLE, FL, 32796
MARSHALL BENJAMIN G Agent 1785 GARDEN STREET, TITUSVILLE, FL, 32796

National Provider Identifier

NPI Number:
1699447086
Certification Date:
2021-10-25

Authorized Person:

Name:
KATIE FONTAINE
Role:
ADMINISTRATOR
Phone:

Taxonomy:

Selected Taxonomy:
207Q00000X - Family Medicine Physician
Is Primary:
Yes

Contacts:

Fax:
3212698433

Form 5500 Series

Employer Identification Number (EIN):
863013918
Plan Year:
2024
Number Of Participants:
11
Sponsors Telephone Number:
Plan Year:
2023
Number Of Participants:
7
Sponsors Telephone Number:
Plan Year:
2022
Number Of Participants:
8
Sponsors Telephone Number:

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G25000003984 MISSION CONCIERGE CARE ACTIVE 2025-01-08 2030-12-31 - 1785 GARDEN STREET, TITUSVILLE, FL, 32796

Documents

Name Date
ANNUAL REPORT 2025-01-13
ANNUAL REPORT 2024-01-03
ANNUAL REPORT 2023-01-04
ANNUAL REPORT 2022-01-18
Florida Limited Liability 2021-03-22

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Date of last update: 03 Aug 2025

Sources: Florida Department of State