| Entity Name: | INTEGRITY PRIMARY MED LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 14 Mar 2022 (3 years ago) |
| Document Number: | L22000127193 |
| FEI/EIN Number | 880922477 |
| Address: | 10491 6 MILE CYPRESS PKWY, STE 271, FORT MYERS, FL, 33966, US |
| Mail Address: | 10491 6 MILE CYPRESS PKWY, STE 271, FORT MYERS, FL, 33966, US |
| ZIP code: | 33966 |
| County: | Lee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1497402531 | 2022-03-08 | 2023-07-11 | 10491 6 MILE CYPRESS PKWY STE 271, FORT MYERS, FL, 339666518, US | 10491 6 MILE CYPRESS PKWY STE 271, FORT MYERS, FL, 339666518, US | |||||||||||||||||||||||||||
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| Phone | +1 239-215-3500 |
| Fax | 2392153525 |
Authorized person
| Name | DR. EILEEN C CALLAWAY |
| Role | CEO / OWNER / MEDICAL DIRECTOR |
| Phone | 2392153500 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 114316000 |
| State | FL |
| Issuer | BLUE CROSS - BLUE SHIELD |
| Number | XGZN9 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CALLAWAY EILEEN CMD | Agent | 10491 6 MILE CYPRESS PKWY, FORT MYERS, FL, 33966 |
| Name | Role | Address |
|---|---|---|
| CALLAWAY EILEEN CMD | Manager | 10730 PRATO DRIVE, FORT MYERS, FL, 33913 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2025-06-01 | 10491 6 MILE CYPRESS PKWY, STE 271, FORT MYERS, FL 33966 | No data |
| CHANGE OF MAILING ADDRESS | 2025-06-01 | 10491 6 MILE CYPRESS PKWY, STE 271, FORT MYERS, FL 33966 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2024-06-01 | 10491 6 MILE CYPRESS PKWY, STE 271, FORT MYERS, FL 33966 | No data |
| CHANGE OF MAILING ADDRESS | 2024-06-01 | 10491 6 MILE CYPRESS PKWY, STE 271, FORT MYERS, FL 33966 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-03-01 | 10491 6 MILE CYPRESS PKWY, STE 271, FORT MYERS, FL 33966 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-01 |
| ANNUAL REPORT | 2023-03-16 |
| Florida Limited Liability | 2022-03-14 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
