| Entity Name: | MP PRIMARY CARE SERVICES, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 20 Apr 2022 (3 years ago) |
| Document Number: | L22000188316 |
| FEI/EIN Number | 88-2215995 |
| Address: | 2778 US Hwy 27 S, Avon Park, FL, 33825, US |
| Mail Address: | 5063 MOSS HAMMOCK TRL, SEBRING, FL, 33872, US |
| ZIP code: | 33825 |
| County: | Highlands |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1609512656 | 2022-05-11 | 2024-07-15 | 2778 US HIGHWAY 27 S, AVON PARK, FL, 338259755, US | 2778 US HIGHWAY 27 S, AVON PARK, FL, 338259755, US | |||||||||||||||||||||||
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| Phone | +1 863-358-0500 |
| Fax | 8633580508 |
Authorized person
| Name | ORLAND MATA |
| Role | CEO |
| Phone | 8638400639 |
Taxonomy
| Taxonomy Code | 207RN0300X - Nephrology Physician |
| Is Primary | Yes |
| Taxonomy Code | 261QM0801X - Mental Health Clinic/Center (Including Community Mental Health Center) |
| Is Primary | No |
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| PUJOLS JEILA S | Agent | 5063 Moss Hammock Trl, SEBRING, FL, 33872 |
| Name | Role | Address |
|---|---|---|
| PUJOLS JEILA S | Manager | 5926 ORION DR, SEBRING, FL, 33872 |
| MATA CRUZ ORLAND | Manager | 5926 ORION DR, SEBRING, FL, 33872 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G22000099415 | MP HEALTHCARE | ACTIVE | 2022-08-23 | 2027-12-31 | No data | 4145 SUN N LAKE BLVD, STE A, SEBRING, FL, 33872 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-04-06 | 2778 US Hwy 27 S, Avon Park, FL 33825 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-04-06 | 5063 Moss Hammock Trl, SEBRING, FL 33872 | No data |
| CHANGE OF MAILING ADDRESS | 2022-08-23 | 2778 US Hwy 27 S, Avon Park, FL 33825 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-13 |
| ANNUAL REPORT | 2023-04-06 |
| Florida Limited Liability | 2022-04-20 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
