| Entity Name: | MOBILE MEDICAL OPERATING COMPANY, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 19 Jan 2022 (3 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 01 Feb 2022 (3 years ago) |
| Document Number: | L22000032970 |
| FEI/EIN Number | 87-4730119 |
| Address: | 1840 SE PORT SAINT LUCIE BLVD., Ste 1840, PORT ST LUCIE, FL 34952-0554 |
| Mail Address: | 4655 SALISBURY RD STE 110, JACKSONVILLE, FL 32256 |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1245983022 | 2022-02-01 | 2024-09-25 | 4655 SALISBURY RD STE 110, JACKSONVILLE, FL, 322560957, US | 1840 SE PORT ST LUCIE BLVD STE 1840, PORT ST LUCIE, FL, 349525545, US | |||||||||||||||||||||||||||||||||||||||
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| Phone | +1 904-733-1003 |
| Fax | 9044488855 |
| Phone | +1 772-221-7620 |
| Fax | 7722219903 |
Authorized person
| Name | MR. ROBERT YOUNG |
| Role | SECRETARY & CAO |
| Phone | 9047331003 |
Taxonomy
| Taxonomy Code | 101YM0800X - Mental Health Counselor |
| Is Primary | No |
| Taxonomy Code | 208D00000X - General Practice Physician |
| Is Primary | Yes |
| Taxonomy Code | 363LP0808X - Psychiatric/Mental Health Nurse Practitioner |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 117201700 |
| State | FL |
| Issuer | AHCA |
| Number | 13404 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| YOUNG, ROBERT GREG | Agent | 4655 SALISBURY ROAD, SUITE 110, JACKSONVILLE, FL 32256 |
| Name | Role | Address |
|---|---|---|
| RUCKER, DAVID C | Chief Executive Officer | 4655 SALISBURY ROAD, SUITE 110, JACKSONVILLE, FL 32256 |
| Name | Role | Address |
|---|---|---|
| FISHER, JEFFREY L | President | 4655 SALISBURY ROAD, SUITE 110, JACKSONVILLE, FL 32256 |
| Name | Role | Address |
|---|---|---|
| MMOC HOLDINGS, LLC | Managing Member | 4655 SALISBURY RD STE 110, JACKSONVILLE, FL 32256 |
| Name | Role | Address |
|---|---|---|
| YOUNG, ROBERT GREG | Secretary | 4655 SALISBURY ROAD, SUITE 110, JACKSONVILLE, FL 32256 |
| Name | Role | Address |
|---|---|---|
| Young, Robert Greg | Chief Financial Officer | 4655 SALISBURY RD STE 110, JACKSONVILLE, FL 32256 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G22000012768 | MOBILE MEDICAL | ACTIVE | 2022-01-31 | 2027-12-31 | No data | 4655 SALISBURY ROAD SUITE 110, JACKSONVILLE, FL, 32256 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-10-09 | 1840 SE PORT SAINT LUCIE BLVD., Ste 1840, PORT ST LUCIE, FL 34952-0554 | No data |
| LC AMENDMENT | 2022-02-01 | No data | No data |
| LC AMENDMENT | 2022-01-31 | No data | No data |
| Name | Date |
|---|---|
| AMENDED ANNUAL REPORT | 2024-11-13 |
| ANNUAL REPORT | 2024-02-14 |
| ANNUAL REPORT | 2023-02-09 |
| LC Amendment | 2022-02-01 |
| LC Amendment | 2022-01-31 |
| Florida Limited Liability | 2022-01-19 |
Date of last update: 13 Jan 2025
Sources: Florida Department of State
