| Entity Name: | ARKIM PRIMARY CARE CLINIC LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 08 Jun 2022 (3 years ago) |
| Document Number: | L22000261565 |
| FEI/EIN Number | 88-2762759 |
| Address: | 1853 SE Port Saint Lucie Blvd, PORT SAINT LUCIE, FL, 34952, US |
| Mail Address: | 1853 SE Port Saint Lucie Blvd, PORT SAINT LUCIE, FL, 34952, US |
| ZIP code: | 34952 |
| County: | St. Lucie |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1871204867 | 2022-12-09 | 2023-07-10 | 1853 SE PORT ST LUCIE BLVD, PORT SAINT LUCIE, FL, 349525530, US | 1853 SE PORT ST LUCIE BLVD, PORT SAINT LUCIE, FL, 349525530, US | |||||||||||||||||||||
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| Phone | +1 772-237-5244 |
| Fax | 7729058047 |
Authorized person
| Name | KALI GARCIA MALPICA |
| Role | PRESIDENT |
| Phone | 7722375244 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 117047600 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| GARCIA MALPICA KALI | Agent | 1682 SW ALBERCA LN, PORT SAINT LUCIE, FL, 34953 |
| Name | Role | Address |
|---|---|---|
| GARCIA MALPICA KALI | Authorized Member | 1682 SW ALBERCA LN, PORT SAINT LUCIE, FL, 34953 |
| CUELLAR SOPENA IVAN | Authorized Member | 1682 SW ALBERCA LN, PORT SAINT LUCIE, FL, 34953 |
| VALENZUELA FLEITAS JOSE L | Authorized Member | 20880 ORTEGA ST, ORLANDO, FL, 32833 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-05-01 | 1853 SE Port Saint Lucie Blvd, PORT SAINT LUCIE, FL 34952 | No data |
| CHANGE OF MAILING ADDRESS | 2023-05-01 | 1853 SE Port Saint Lucie Blvd, PORT SAINT LUCIE, FL 34952 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-14 |
| ANNUAL REPORT | 2023-01-30 |
| Florida Limited Liability | 2022-06-08 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
