| Entity Name: | PROTEAN PATHOLOGY SERVICES LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 11 May 2022 (3 years ago) |
| Document Number: | L22000222452 |
| FEI/EIN Number | 88-2252740 |
| Address: | 6555 SANGER ROAD, STE 260, ORLANDO, FL 32827 |
| Mail Address: | 6555 SANGER ROAD, STE 260, ORLANDO, FL 32827 |
| ZIP code: | 32827 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1285372490 | 2022-05-26 | 2022-12-30 | 6555 SANGER RD STE 260, ORLANDO, FL, 328277686, US | 6555 SANGER RD STE 260, ORLANDO, FL, 328277686, US | |||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||
| Phone | +1 754-242-9682 |
| Fax | 8136947006 |
Authorized person
| Name | DR. ANTHONY MAGLIOCCO |
| Role | MANAGING DIRECTOR |
| Phone | 8138172042 |
Taxonomy
| Taxonomy Code | 207SG0201X - Clinical Genetics (M.D.) Physician |
| Is Primary | No |
| Taxonomy Code | 207ZC0500X - Cytopathology Physician |
| Is Primary | No |
| Taxonomy Code | 207ZP0007X - Molecular Genetic Pathology (Pathology) Physician |
| Is Primary | No |
| Taxonomy Code | 207ZP0101X - Anatomic Pathology Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | FLORIDA BLUE |
| Number | O4QJT |
| Name | Role |
|---|---|
| PROTEAN BIODIAGNOSTICS INC. | Agent |
| Name | Role |
|---|---|
| PROTEAN BIODIAGNOSTICS INC. | Authorized Member |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-28 |
| ANNUAL REPORT | 2023-04-23 |
| Florida Limited Liability | 2022-05-11 |
Date of last update: 11 Feb 2025
Sources: Florida Department of State
