| Entity Name: | VIVANT HEALTH, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 23 Jan 2023 (2 years ago) |
| Document Number: | L23000042904 |
| FEI/EIN Number | 92-2034814 |
| Address: | 10425 SOUTH LAGO VISTA CIR, PARKLAND, FL 33076 |
| Mail Address: | 10425 SOUTH LAGO VISTA CIR, PARKLAND, FL 33076 |
| ZIP code: | 33076 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1942987474 | 2023-06-27 | 2024-03-19 | 10425 S LAGO VISTA CIR, PARKLAND, FL, 330762970, US | 660 GLADES RD STE 140, BOCA RATON, FL, 334316466, US | |||||||||||||||||
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| Phone | +1 561-800-2601 |
| Phone | +1 561-800-4570 |
| Fax | 5618004580 |
Authorized person
| Name | DR. PRASANTH GOGINENI |
| Role | PRESIDENT |
| Phone | 5618002601 |
Taxonomy
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| GOGINENI, PRASANTH, DR. | Agent | 10425 SOUTH LAGO VISTA CIR, PARKLAND, FL 33076 |
| Name | Role | Address |
|---|---|---|
| GOGINENI, PRASANTH, DR. | Authorized Member | 10425 SOUTH LAGO VISTA CIR, PARKLAND, FL 33076 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-08 |
| Florida Limited Liability | 2023-01-23 |
Date of last update: 10 Feb 2025
Sources: Florida Department of State
