| Entity Name: | ACCESS MEDICAL GROUP OF RIVERVIEW, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 21 Apr 2022 (3 years ago) |
| Document Number: | L22000191824 |
| FEI/EIN Number | 88-2284518 |
| Mail Address: | 7700 FORSYTH BLVD., ST. LOUIS, MO 63105 |
| Address: | 6100 BLUE LAGOON DRIVE, MIAMI, FL 33126 |
| ZIP code: | 33126 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1457099582 | 2022-05-27 | 2023-10-19 | 6100 BLUE LAGOON DR STE 365, MIAMI, FL, 331267010, US | 9088 PROGRESS BLVD UNIT 2-4, RIVERVIEW, FL, 335784886, US | |||||||||||||||||||||||||
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| Phone | +1 786-322-7333 |
| Fax | 7863475022 |
| Phone | +1 813-444-0220 |
| Fax | 8133671961 |
Authorized person
| Name | MR. RAYNY RAMIREZ |
| Role | PRESIDENT |
| Phone | 7863227333 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 117487900 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CT CORPORATION SYSTEM | Agent | 1200 SOUTH PINE ISLAND ROAD, PLANTATION, FL 33324 |
| Name | Role | Address |
|---|---|---|
| KOSTER, CHRISTOPHER A | Manager | 7700 FORSYTH BLVD., ST. LOUIS, MO 63105 |
| CHERVITZ, CHARLES | Manager | 7700 FORSYTH BLVD, ST. LOUIS, MO 63105 |
| Name | Role | Address |
|---|---|---|
| KOSTER, CHRISTOPHER A | Secretary | 7700 FORSYTH BLVD., ST. LOUIS, MO 63105 |
| Name | Role | Address |
|---|---|---|
| Dinkelman, Tricia | Vice President | 7700 FORSYTH BLVD., ST. LOUIS, MO 63105 |
| Baiocchi, Sarah | Vice President | 7700 FORSYTH BLVD., ST. LOUIS, MO 63105 |
| Majors, Richard | Vice President | 6100 BLUE LAGOON DRIVE, MIAMI, FL 33126 |
| Name | Role | Address |
|---|---|---|
| Dinkelman, Tricia | Tax | 7700 FORSYTH BLVD., ST. LOUIS, MO 63105 |
| Name | Role | Address |
|---|---|---|
| Ramirez, Rayny | President | 6100 BLUE LAGOON DRIVE, MIAMI, FL 33126 |
| Name | Role | Address |
|---|---|---|
| Majors, Richard | Finance | 6100 BLUE LAGOON DRIVE, MIAMI, FL 33126 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G22000059907 | COMMUNITY MEDICAL GROUP | ACTIVE | 2022-05-12 | 2027-12-31 | No data | 7700 FORSYTH BLVD., ST. LOUIS, MO, 63105 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-29 |
| AMENDED ANNUAL REPORT | 2023-05-23 |
| ANNUAL REPORT | 2023-05-01 |
| Florida Limited Liability | 2022-04-21 |
Date of last update: 12 Jan 2025
Sources: Florida Department of State
