| Entity Name: | MIRA WOMEN'S HEALTH AND MIDWIFERY LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 28 Jun 2024 (7 months ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 23 Aug 2024 (5 months ago) |
| Document Number: | L24000291102 |
| FEI/EIN Number | 993792316 |
| Address: | 1601 CLINT MOORE RD., BOCA RATON, FL, 33487, US |
| Mail Address: | 1601 CLINT MOORE RD., BOCA RATON, FL, 33487, US |
| ZIP code: | 33487 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1427894880 | 2024-07-05 | 2024-09-23 | 1601 CLINT MOORE RD STE 210, BOCA RATON, FL, 334875716, US | 1601 CLINT MOORE RD STE 210, BOCA RATON, FL, 334875716, US | |||||||||||||||||||||||||||||
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| Phone | +1 561-488-1801 |
| Fax | 5614511480 |
Authorized person
| Name | KENNETH A KONSKER |
| Role | CEO AND PHYSICIAN |
| Phone | 5617890559 |
Taxonomy
| Taxonomy Code | 176B00000X - Midwife |
| Is Primary | No |
| Taxonomy Code | 207VG0400X - Gynecology Physician |
| Is Primary | Yes |
| Taxonomy Code | 207VX0000X - Obstetrics Physician |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 14278954880 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| KONSKER KENNETH | Agent | 1601 CLINT MOORE RD., BOCA RATON, FL, 33487 |
| Name | Role | Address |
|---|---|---|
| KONSKER KENNETH | Authorized Member | 8730 TWIN LAKE DR, BOCA RATON, FL, 33428 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC AMENDMENT | 2024-08-23 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2024-08-23 | 1601 CLINT MOORE RD., SUITE 210, BOCA RATON, FL 33487 | No data |
| CHANGE OF MAILING ADDRESS | 2024-08-23 | 1601 CLINT MOORE RD., SUITE 210, BOCA RATON, FL 33487 | No data |
| LC AMENDMENT | 2024-07-26 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-07-26 | 1601 CLINT MOORE RD., SUITE 210, BOCA RATON, FL 33487 | No data |
| Name | Date |
|---|---|
| LC Amendment | 2024-08-23 |
| LC Amendment | 2024-07-26 |
| Florida Limited Liability | 2024-06-28 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
