| Entity Name: | BROADER MRI OF FT.PIERCE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 11 Aug 2022 (2 years ago) |
| Document Number: | L22000365068 |
| FEI/EIN Number | 88-3583771 |
| Address: | 2735 PETERS RD #37, FT. PIERCE, FL 34945 |
| Mail Address: | 4224 HOLLYWOOD BLVD, HOLLYWOOD, FL 33021 |
| ZIP code: | 34945 |
| County: | St. Lucie |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1376240101 | 2023-02-13 | 2023-02-13 | BROADER MRI OF FT PIERCE, LLC, 4224 HOLLYWOOD BLVD, HOLLYWOOD, FL, 33021, US | 2725 PETERS RD #37, FT.PIERCE, FL, 34948, US | |||||||||||||||||||||||||||
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| Phone | +1 954-966-3600 |
| Fax | 9549671962 |
Authorized person
| Name | MR. ANGEL L SOTO |
| Role | OWNER, PRESIDENT |
| Phone | 9549663600 |
Taxonomy
| Taxonomy Code | 2085R0202X - Diagnostic Radiology Physician |
| Is Primary | Yes |
| Taxonomy Code | 261Q00000X - Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 261QM1200X - Magnetic Resonance Imaging (MRI) Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 261QR0200X - Radiology Clinic/Center |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| SOTO, ANGEL | Agent | 4224 HOLLYWOOD BLVD, HOLLYWOOD, FL 33021 |
| Name | Role | Address |
|---|---|---|
| SOTO, ANGEL | Authorized Member | 4224 HOLLYWOOD BLVD, HOLLYWOOD, FL 33021 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-14 |
| ANNUAL REPORT | 2023-03-29 |
| Florida Limited Liability | 2022-08-11 |
Date of last update: 11 Jan 2025
Sources: Florida Department of State
