| Entity Name: | ADVANCED PEDIATRIC PULMONOLOGY, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 06 Jun 2023 (2 years ago) |
| Document Number: | L23000273117 |
| FEI/EIN Number | 93-1984497 |
| Address: | 1951 SW 172nd Ave, Ste 3128, Miramar, FL 33029 |
| Mail Address: | 2701 BISCAYNE BLVD., APT 7102, MIAMI, FL 33137 |
| ZIP code: | 33029 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1053095265 | 2023-06-09 | 2024-08-05 | 2701 BISCAYNE BLVD APT 7102, MIAMI, FL, 331375302, US | 1971 SW 172ND AVE STE 3128, MIRAMAR, FL, 330295592, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 914-462-7411 |
| Phone | +1 954-299-5272 |
| Fax | 8555833365 |
Authorized person
| Name | DR. MARIE MYRTHA GREGOIRE-BOTTEX |
| Role | MANAGING MEMBER |
| Phone | 9144627411 |
Taxonomy
| Taxonomy Code | 2080P0214X - Pediatric Pulmonology Physician |
| Is Primary | Yes |
| Taxonomy Code | 261QM2500X - Medical Specialty Clinic/Center |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 102074500 |
| State | FL |
| Issuer | CLIA |
| Number | 10D2296465 |
| State | FL |
| Issuer | MEDICAID |
| Number | 00118945800 |
| State | FL |
| Issuer | FLORIDA BLUE PROVIDER |
| Number | 2HXM4 |
| State | FL |
| Issuer | CAQH |
| Number | 11995072 |
| Issuer | FLORIDA BLUE |
| Number | 1J6FX |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MARIE MYRTHA GREGOIRE-BOTTEX, MD | Agent | 2701 BISCAYNE BLVD., APT 7102, MIAMI, FL 33137 |
| Name | Role | Address |
|---|---|---|
| MARIE MYRTHA GREGOIRE-BOTTEX, MD | Manager | 2701 BISCAYNE BLVD., APT 7102, MIAMI, FL 33137 |
| Name | Role | Address |
|---|---|---|
| Bottex, Erve Marie Antonin Erve, Dr. | Authorized Representative | 2701 Biscayne Blvd apt 7102, MIami, FL 33137 |
| Name | Role | Address |
|---|---|---|
| MARIE MYRTHA GREGOIRE-BOTTEX, MD | Member | 2701 BISCAYNE BLVD., APT 7102, MIAMI, FL 33137 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-08-01 | 1951 SW 172nd Ave, Ste 3128, Miramar, FL 33029 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-15 |
| Florida Limited Liability | 2023-06-06 |
Date of last update: 10 Feb 2025
Sources: Florida Department of State
