| Entity Name: | OMNI MEDICAL GROUP, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 27 Jun 2023 (2 years ago) |
| Document Number: | L23000307213 |
| FEI/EIN Number | 93-2106755 |
| Address: | 7431 N. University Drive, Suite 200, Tamarac, FL 33321 |
| Mail Address: | 7431 N. University Drive, Suite 200, Tamarac, FL 33321 |
| ZIP code: | 33321 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1629751466 | 2023-08-09 | 2024-04-19 | 7431 N UNIVERSITY DR STE 200, TAMARAC, FL, 333212956, US | 7431 N UNIVERSITY DR STE 200, TAMARAC, FL, 333212956, US | |||||||||||||||||||||
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| Phone | +1 954-551-4849 |
Authorized person
| Name | DR. JOHN B PASSANTINO |
| Role | CEO, PHYSICIAN |
| Phone | 9544950771 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | Yes |
| Taxonomy Code | 2081S0010X - Sports Medicine (Physical Medicine & Rehabilitation) Physician |
| Is Primary | No |
| Name | Role |
|---|---|
| UNITED STATES CORPORATION AGENTS, INC. | Agent |
| Name | Role | Address |
|---|---|---|
| PASSANTINO, JOHN B | Authorized Member | 6005 NW 56TH CIR, CORAL SPRINGS, FL 33067 |
| AUSTIN, SHANE N | Authorized Member | 6005 NW 56TH CIR, CORAL SPRINGS, FL 33067 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-01-26 | 7431 N. University Drive, Suite 200, Tamarac, FL 33321 | No data |
| CHANGE OF MAILING ADDRESS | 2024-01-26 | 7431 N. University Drive, Suite 200, Tamarac, FL 33321 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-17 |
| Florida Limited Liability | 2023-06-27 |
Date of last update: 09 Feb 2025
Sources: Florida Department of State
