| Entity Name: | ACCESS MEDICAL GROUP OF PEMBROKE PINES, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 21 Apr 2022 (3 years ago) |
| Document Number: | L22000191899 |
| FEI/EIN Number | 882251274 |
| Address: | 6100 BLUE LAGOON DRIVE, MIAMI, FL, 33126, UN |
| Mail Address: | 7700 FORSYTH BLVD., ST. LOUIS, MO, 63105, UN |
| ZIP code: | 33126 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1235876004 | 2022-05-13 | 2023-10-19 | 6100 BLUE LAGOON DR STE 365, MIAMI, FL, 331267010, US | 10060 NW 7TH ST UNIT 10, PEMBROKE PINES, FL, 330246158, US | |||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||
| Phone | +1 786-322-7333 |
| Fax | 7863475022 |
| Phone | +1 954-606-0110 |
| Fax | 9544954162 |
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 | 117583400 |
| 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 |
|---|---|---|
| Dinkelman Tricia | Vice President | 7700 FORSYTH BLVD., ST. LOUIS, 63105 |
| Baiocchi Sarah | Vice President | 7700 FORSYTH BLVD., ST. LOUIS, 63105 |
| Majors Richard A | Vice President | 6100 BLUE LAGOON DRIVE, MIAMI, 33126 |
| Name | Role | Address |
|---|---|---|
| Ramirez Rayny | President | 6100 BLUE LAGOON DRIVE, MIAMI, 33126 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G22000059904 | COMMUNITY MEDICAL GROUP | ACTIVE | 2022-05-12 | 2027-12-31 | No data | 7700 FORSYTH BLVD., ST. LOUIS, MO, 63105 |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J24000534451 | ACTIVE | 1000001007492 | BROWARD | 2024-08-13 | 2034-08-21 | $ 502.98 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, MIAMI SERVICE CENTER, 3750 NW 87TH AVE STE 300, DORAL FL331782430 |
| 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: 03 Feb 2025
Sources: Florida Department of State
