| Entity Name: | SOURCE MEDICAL GROUP, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 16 Feb 2024 (a year ago) |
| Document Number: | L24000084264 |
| Address: | 208 SE 8TH ST, FORT LAUDERDALE, FL, 33316, US |
| Mail Address: | 7601 N FEDERAL HWY STE 245A, BOCA RATON, FL, 33487, US |
| ZIP code: | 33316 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1871358853 | 2024-02-19 | 2024-02-19 | 7601 N FEDERAL HWY STE 245A, BOCA RATON, FL, 334871672, US | 208 SE 8TH ST, FT LAUDERDALE, FL, 333161014, US | |||||||||||||
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| Phone | +1 561-704-6781 |
Authorized person
| Name | TROY GARR |
| Role | AMBR |
| Phone | 2155708300 |
Taxonomy
| Taxonomy Code | 261QM1300X - Multi-Specialty Clinic/Center |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| GARR TROY | Agent | 7601 N FEDERAL HWY STE 245A, BOCA RATON, FL, 33487 |
| Name | Role | Address |
|---|---|---|
| GARR TROY | Authorized Member | 7601 N FEDERAL HWY STE 245A, BOCA RATON, FL, 33487 |
| Name | Date |
|---|---|
| Florida Limited Liability | 2024-02-16 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
