| Entity Name: | MY TELEVISIT MD LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 22 Mar 2024 (10 months ago) |
| Document Number: | L24000141446 |
| Address: | 5560 ROOSEVELT BLVD, SUITE 4 #50, CLEARWATER, FL, 33760 |
| Mail Address: | 33092 PATRICE RD, DADE CITY, FL, 33523 |
| ZIP code: | 33760 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1174374011 | 2024-03-28 | 2024-03-28 | 5560 ROOSEVELT BOULEVARD, SUITE 4 #50, CLEARWATER, FL, 337609228, US | 5560 ROOSEVELT BOULEVARD, SUITE 4 #50, CLEARWATER, FL, 33760, US | |||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 727-415-2308 |
Authorized person
| Name | MR. MICHAEL PAUL BAGBY |
| Role | CEO/AMBR |
| Phone | 7274152308 |
Taxonomy
| Taxonomy Code | 101YM0800X - Mental Health Counselor |
| Is Primary | No |
| Taxonomy Code | 133NN1002X - Nutrition Education Nutritionist |
| Is Primary | No |
| Taxonomy Code | 163WH0200X - Home Health Registered Nurse |
| Is Primary | No |
| Taxonomy Code | 171M00000X - Case Manager/Care Coordinator |
| Is Primary | Yes |
| Taxonomy Code | 2083P0901X - Public Health & General Preventive Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 208D00000X - General Practice Physician |
| Is Primary | No |
| Taxonomy Code | 261Q00000X - Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 261QR0800X - Recovery Care Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 261QR1300X - Rural Health Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 374U00000X - Home Health Aide |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| BAGBY MICHAEL P | Agent | 5560 ROOSEVELT BLVD, CLEARWATER, FL, 33760 |
| Name | Role | Address |
|---|---|---|
| BAGBY MICHAEL P | Manager | 5560 ROOSEVELT BLVD STE 4 #50, CLEARWATER, FL, 33760 |
| Name | Role | Address |
|---|---|---|
| EVANS PATRICIA | Authorized Member | 5560 ROOSEVELT BLVD STE 4 #50, CLEARWATER, FL, 33760 |
| Name | Date |
|---|---|
| Florida Limited Liability | 2024-03-22 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
