| Entity Name: | BLUEROCK MEDICAL L.L.C. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 07 Nov 2023 (a year ago) |
| Document Number: | L23000504757 |
| FEI/EIN Number | 93-4273067 |
| Address: | 810 NORTH RIDGEWOOD DRIVE, SEBRING, FLORIDA, FL 33870 |
| Mail Address: | 810 NORTH RIDGEWOOD DRIVE, SEBRING, FLORIDA, FL 33870 |
| ZIP code: | 33870 |
| County: | Highlands |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1386408706 | 2024-02-07 | 2024-03-04 | 505 SUMMIT DR, SEBRING, FL, 338702341, US | 810 N RIDGEWOOD DR, SEBRING, FL, 338707217, US | |||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||
| Phone | +1 863-873-0072 |
Authorized person
| Name | MRS. JENNIE LECLAIR SPENCER |
| Role | OWNER |
| Phone | 8638730072 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
| Taxonomy Code | 261QC1500X - Community Health Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 261QI0500X - Infusion Therapy Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 291U00000X - Clinical Medical Laboratory |
| Is Primary | No |
Other Provider Identifiers
| Issuer | NPI |
| Number | 1164189015 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SPENCER, JENNIE L | Agent | 505 SUMMIT DRIVE, SEBRING, FL 33870 |
| Name | Role | Address |
|---|---|---|
| SPENCER, JENNIE L | Manager | 505 SUMMIT DRIVE, SEBRING, FL 33870 |
| Name | Role | Address |
|---|---|---|
| SPENCER, STUART R | Authorized Member | 505 SUMMIT DRIVE, SEBRING, FL 33870 |
| Name | Role | Address |
|---|---|---|
| MONTSDEOCA, GARY, Dr. | Member | 810 NORTH RIDGEWOOD DRIVE, SEBRING, FLORIDA, FL 33870 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-07 |
| Florida Limited Liability | 2023-11-07 |
Date of last update: 08 Jan 2025
Sources: Florida Department of State
