| Entity Name: | BEACON MD LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 29 Mar 2024 (10 months ago) |
| Document Number: | L24000152235 |
| Address: | 2011 S 25TH ST, 106, FORT PIERCE, FL 34947 |
| Mail Address: | 2011 S 25TH ST, 106, FORT PIERCE, FL 34947 |
| ZIP code: | 34947 |
| County: | St. Lucie |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1710734496 | 2024-05-01 | 2024-05-10 | 2011 S 25TH ST STE 106, FORT PIERCE, FL, 349474795, US | 2011 S 25TH ST STE 106, FORT PIERCE, FL, 349474795, US | |||||||||||||||||||||||||
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| Phone | +1 772-229-4770 |
Authorized person
| Name | RAGHAV MOHINDRA |
| Role | PRESIDENT |
| Phone | 7722294770 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | Yes |
| Taxonomy Code | 207RE0101X - Endocrinology, Diabetes & Metabolism Physician |
| Is Primary | No |
| Taxonomy Code | 2084N0400X - Neurology Physician |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| MOHINDRA, RAGHAV | Agent | 7431 COLTON LN, PILOT POINT, FL 76258 |
| Name | Role | Address |
|---|---|---|
| MOHINDRA, RAGHAV | Manager | 7431 COLTON LN, PILOT POINT, TX 76258 |
| GOYAL, AJAY | Manager | 2011 S 25TH ST, 106, FORT PIERCE, FL 34947 |
| Name | Date |
|---|---|
| Florida Limited Liability | 2024-03-29 |
Date of last update: 07 Jan 2025
Sources: Florida Department of State
