| Entity Name: | KINGDOM MEDICAL LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 12 Aug 2024 (5 months ago) |
| Document Number: | L24000353767 |
| Address: | 501 S FALKENBURG RD, A2, TAMPA, FL 33619 |
| Mail Address: | PO BOX 153072, TAMPA, FL 33684 |
| ZIP code: | 33619 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1194548511 | 2024-11-04 | 2024-11-04 | PO BOX 153072, TAMPA, FL, 336843072, US | 501 S FALKENBURG RD, TAMPA, FL, 336198055, US | |||||||||||||||
|
|||||||||||||||||||
| Phone | +1 813-434-1045 |
| Fax | 8134341259 |
Authorized person
| Name | DR. FREDRICK WILLIAMS JR. |
| Role | CLINIC DIRECTOR |
| Phone | 8134950677 |
Taxonomy
| Taxonomy Code | 332B00000X - Durable Medical Equipment & Medical Supplies |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| JELTZ, PRECIOUS | Agent | 501 S FALKENBURG RD, A2, TAMPA, FL 33619 |
| Name | Date |
|---|---|
| Florida Limited Liability | 2024-08-12 |
Date of last update: 07 Jan 2025
Sources: Florida Department of State
