| Entity Name: | DIVINE MEDICAL ASSOCIATES LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 19 Jan 2023 (2 years ago) |
| Document Number: | L23000036714 |
| FEI/EIN Number | 92-1833524 |
| Address: | 136 ANCHOR DRIVE, VERO BEACH, FL 32963 |
| Mail Address: | 136 ANCHOR DRIVE, VERO BEACH, FL 32963 |
| ZIP code: | 32963 |
| County: | Indian River |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1124724828 | 2023-02-03 | 2023-02-03 | 136 ANCHOR DR, VERO BEACH, FL, 329632941, US | 136 ANCHOR DR, VERO BEACH, FL, 329632941, US | |||||||||||||||||||||||||||
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| Phone | +1 513-824-9509 |
| Fax | 7723652818 |
Authorized person
| Name | MEGAN E ELAINE KAMERER HILL |
| Role | PHYSICIAN/OWNER |
| Phone | 5138249509 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1821080946 |
| State | PA |
| Issuer | MEDICAID |
| Number | 1487896791 |
| State | OH |
| Name | Role | Address |
|---|---|---|
| HILL, ROBERT | Agent | 136 ANCHOR DRIVE, VERO BEACH, FL 32963 |
| Name | Role | Address |
|---|---|---|
| KAMERER HILL, MEGAN | Authorized Member | 136 ANCHOR DRIVE, VERO BEACH, FL 32963 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-31 |
| Florida Limited Liability | 2023-01-19 |
Date of last update: 10 Feb 2025
Sources: Florida Department of State
