| Entity Name: | FAMILY MEDICAL GROUP HML, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 07 Jan 2022 (3 years ago) |
| Last Event: | LC AMENDMENT AND NAME CHANGE |
| Event Date Filed: | 18 Mar 2022 (3 years ago) |
| Document Number: | L22000017525 |
| FEI/EIN Number | 87-4465832 |
| Address: | 7100 W 20 AVE STE 616, HIALEAH, FL, 33016, US |
| Mail Address: | 9000 SW 137th AVE, SUITE 201, MIAMI, FL, 33186, US |
| ZIP code: | 33016 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1104540830 | 2022-09-27 | 2022-09-29 | 7100 W 20TH AVE STE 616, HIALEAH, FL, 330161814, US | 7100 W 20TH AVE STE 616, HIALEAH, FL, 330161814, US | |||||||||||||||||||||
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| Phone | +1 305-435-4465 |
| Fax | 3599022506 |
Authorized person
| Name | LIZSANDRA RODRIGUEZ |
| Role | OWNER |
| Phone | 7863997390 |
Taxonomy
| Taxonomy Code | 208D00000X - General Practice Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICARE |
| Number | JG446A |
| State | FL |
| Name | Role |
|---|---|
| LJIR ENTERPRISES LLC | Agent |
| Name | Role | Address |
|---|---|---|
| LJIR ENTERPRISES LLC | Authorized Member | No data |
| ALVAREZ MICHELLE M | Authorized Member | 9000 SW 137th AVE, MIAMI, FL, 33186 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G24000037176 | PRECISION MEDICAL CLEARANCES - HIALEAH | ACTIVE | 2024-03-13 | 2029-12-31 | No data | 7100 W 20 AVE, SUITE 616, HIALEAH, FL, 33016 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2024-04-22 | 7100 W 20 AVE STE 616, HIALEAH, FL 33016 | No data |
| REGISTERED AGENT NAME CHANGED | 2024-04-22 | LJIR ENTERPRISES LLC | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-04-22 | 9000 SW 137th AVE, SUITE 201, MIAMI, FL 33186 | No data |
| LC AMENDMENT AND NAME CHANGE | 2022-03-18 | FAMILY MEDICAL GROUP HML, LLC | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2022-03-18 | 7100 W 20 AVE STE 616, HIALEAH, FL 33016 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-22 |
| ANNUAL REPORT | 2023-01-23 |
| LC Amendment and Name Change | 2022-03-18 |
| Florida Limited Liability | 2022-01-07 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
