| Entity Name: | BEACON PRIMARY CARE LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 14 Dec 2021 (3 years ago) |
| Document Number: | L21000525543 |
| FEI/EIN Number | 87-4012004 |
| Address: | 3959 Van Dyke Road Ste 175, LUTZ, FL, 33558, US |
| Mail Address: | 3959 Van Dyke Road Ste 175, LUTZ, FL, 33558, US |
| ZIP code: | 33558 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1184384349 | 2021-12-29 | 2021-12-29 | 17819 TIDEWATER BAY LN, LUTZ, FL, 335495419, US | 17819 TIDEWATER BAY LN, LUTZ, FL, 335495419, US | |||||||||||||
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| Phone | +1 813-447-9249 |
Authorized person
| Name | TYLER PENROD |
| Role | BILLER |
| Phone | 8322899225 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| SEGUI SONIA M | Agent | 3959 Van Dyke Road Ste 175, LUTZ, FL, 33558 |
| Name | Role | Address |
|---|---|---|
| SEGUI SONIA M | President | 3959 Van Dyke Road Ste 175, LUTZ, FL, 33558 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-04-30 | 3959 Van Dyke Road Ste 175, LUTZ, FL 33558 | No data |
| CHANGE OF MAILING ADDRESS | 2022-09-06 | 3959 Van Dyke Road Ste 175, LUTZ, FL 33558 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-09-06 | 3959 Van Dyke Road Ste 175, LUTZ, FL 33558 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-07-24 |
| ANNUAL REPORT | 2023-04-30 |
| ANNUAL REPORT | 2022-09-06 |
| Florida Limited Liability | 2021-12-14 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
