| Entity Name: | PBC FOOT ANKLE CENTER LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 06 Sep 2023 (a year ago) |
| Document Number: | L23000415926 |
| FEI/EIN Number | 93-3330472 |
| Address: | 796 PATRICK DR, WEST PALM BEACH, FL, 33406, US |
| Mail Address: | 796 PATRICK DR, WEST PALM BEACH, FL, 33406, US |
| ZIP code: | 33406 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1679350060 | 2023-09-11 | 2023-09-11 | 796 PATRICK DR, WEST PALM BEACH, FL, 334064434, US | 4362 NORTHLAKE BLVD STE 209, PALM BEACH GARDENS, FL, 334106270, US | |||||||||||||||||||||||
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| Phone | +1 561-329-2299 |
| Phone | +1 561-345-2299 |
| Fax | 8888301589 |
Authorized person
| Name | JUAN SARDINA |
| Role | MANAGER |
| Phone | 5613292299 |
Taxonomy
| Taxonomy Code | 261QP1100X - Podiatric Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICARE |
| Number | 1306099304 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SARDINA JUAN | Agent | 796 PATRICK DR, WEST PALM BEACH, FL, 33406 |
| Name | Role | Address |
|---|---|---|
| SARDINA JUAN | Manager | 796 PATRICK DR, WEST PALM BEACH, FL, 33406 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-15 |
| Florida Limited Liability | 2023-09-06 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
