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PROACTIVE MD FL LLC - Florida Company Profile

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Company Details

Entity Name: PROACTIVE MD FL LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Active
Date Filed: 13 Mar 2024 (a year ago)
Document Number: L24000127210
FEI/EIN Number NOT APPLICABLE
Address: 124 ALLAWOOD COURT, SIMPSONVILLE, SC, 29681, US
Mail Address: 124 ALLAWOOD COURT, SIMPSONVILLE, SC, 29681, US
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
Collier John P Manager 124 ALLAWOOD COURT, SIMPSONVILLE, SC, 29681
Leete David Manager 124 ALLAWOOD COURT, SIMPSONVILLE, SC, 29681
CT CORPORATION SYSTEM Agent 1200 S PINE ISLAND ROAD, PLANTATION, FL, 33324

National Provider Identifier

NPI Number:
1639926991
Certification Date:
2024-11-22

Authorized Person:

Name:
JODY ADDAIR
Role:
CLINICAL OPS PROJECT COORDINATOR
Phone:

Taxonomy:

Selected Taxonomy:
261QP2300X - Primary Care Clinic/Center
Is Primary:
Yes

Contacts:

Documents

Name Date
Florida Limited Liability 2024-03-13

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Date of last update: 01 Aug 2025

Sources: Florida Department of State