| Entity Name: | COLUMBIA MEDICAL IDTF, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 27 Jun 2023 (2 years ago) |
| Document Number: | L23000308464 |
| FEI/EIN Number | 93-2089131 |
| Address: | 6600 NORTHWEST 16TH STREET, SUITE 1, PLANTATION, FL, 33313, UN |
| Mail Address: | 6600 NORTHWEST 16TH ST, SUITE 1, PLANTATION, FL, 33313, UN |
| ZIP code: | 33313 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1700562311 | 2023-06-27 | 2023-07-07 | 6600 NW 16TH ST STE 1, PLANTATION, FL, 333134554, US | 6600 NW 16TH ST STE 1, PLANTATION, FL, 333134554, US | |||||||||||||||
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| Phone | +1 954-381-7110 |
| Fax | 7542063958 |
Authorized person
| Name | MR. THOMAS O MARAZON |
| Role | OWNER |
| Phone | 9543817110 |
Taxonomy
| Taxonomy Code | 293D00000X - Physiological Laboratory |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| DUFFY KAREN | Agent | 6600 NORTHWEST 16TH ST, PLANTATION, FL, 33313 |
| Name | Role | Address |
|---|---|---|
| Meyer Drew A | Manager | 6600 NORTHWEST 16TH ST, SUITE 1, PLANTATION, 33313 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G24000055714 | COLUMBIA MEDICAL WELLCARE LLC | ACTIVE | 2024-04-26 | 2029-12-31 | No data | 6600 NORTHWEST 16TH STREET, SUITE 1, PLANTATION, FL, 33313 |
| Name | Date |
|---|---|
| AMENDED ANNUAL REPORT | 2024-08-27 |
| ANNUAL REPORT | 2024-04-05 |
| Florida Limited Liability | 2023-06-27 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
