| Entity Name: | FOREST HILL MEDICAL GROUP, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 08 Apr 2021 (4 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 24 May 2021 (4 years ago) |
| Document Number: | L21000163936 |
| FEI/EIN Number | 86-3573909 |
| Address: | 3098 FOREST HILL BLVD, PALM SPRINGS, FL, 33406 |
| Mail Address: | PRIMUS HEALTH NETWORK, 2240 WOOLBRIGHT RD STE 317, BOYNTON BEACH, FL, 33426, 22 |
| ZIP code: | 33406 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1205401429 | 2021-05-20 | 2021-11-03 | 2240 WOOLBRIGHT RD, SUITE 317, BOYTON BEACH, FL, 33426, US | 3098 FOREST HILL BLVD, PALM SPRINGS, FL, 334065940, US | |||||||||||||
|
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| Phone | +1 561-968-7600 |
Authorized person
| Name | FRANCISCO PEREZ-MESA |
| Role | OWNER |
| Phone | 5619687600 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| LUCIBELLA RICHARD | Agent | 2240 WOOLBRIGHT RD, BOYNTON BEACH, FL, 33426 |
| Name | Role |
|---|---|
| GIRASOL LLC | Manager |
| PALADIN INC | Manager |
| VAINA, LLC | Manager |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G21000091400 | PALM BEACH FAMILY PHYSICIANS | ACTIVE | 2021-07-15 | 2026-12-31 | No data | 3098 FOREST HILL BLVD, UNIT 1, PALM SPRINGS, FL, 33406 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC AMENDMENT | 2021-05-24 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-13 |
| ANNUAL REPORT | 2023-01-31 |
| ANNUAL REPORT | 2022-01-31 |
| LC Amendment | 2021-05-24 |
| Florida Limited Liability | 2021-04-08 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
