| Entity Name: | VITAL MEDICAL CENTER, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 26 Oct 1989 (35 years ago) |
| Document Number: | L25794 |
| FEI/EIN Number | 65-0170774 |
| Address: | 8300 WEST FLAGLER STREET., 175, MIAMI, FL 33144 |
| Mail Address: | 8300 WEST FLAGLER STREET., 175, MIAMI, FL 33144 |
| ZIP code: | 33144 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1457314064 | 2006-04-07 | 2017-03-29 | 8300 W FLAGLER ST, SUITE #175, MIAMI, FL, 331446000, US | 8300 WEST FLASLER STREET, SUITE #175, MIAMI, FL, 331442098, US | |||||||||||||||||||||||||||||||||||
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| Phone | +1 305-220-0300 |
| Fax | 3052201472 |
Authorized person
| Name | FERNANDO JOSE LORA |
| Role | MD |
| Phone | 3052200300 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| License Number | ME0045837 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | AETNA |
| Number | 0125792 |
| Issuer | MEDICAID |
| Number | 042148100 |
| State | FL |
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | 96904 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| LORA, ERICK | Agent | 8300 W. FLAGLER ST., SUITE 175, MIAMI, FL 33144 |
| Name | Role | Address |
|---|---|---|
| LORA, FERNANDO MD | President | 8300 W. FLAGLER ST. #175, MIAMI, FL |
| Name | Role | Address |
|---|---|---|
| LORA, FERNANDO MD | Treasurer | 8300 W. FLAGLER ST. #175, MIAMI, FL |
| Name | Role | Address |
|---|---|---|
| LORA, FERNANDO MD | Director | 8300 W. FLAGLER ST. #175, MIAMI, FL |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2012-04-16 | 8300 WEST FLAGLER STREET., 175, MIAMI, FL 33144 | No data |
| CHANGE OF MAILING ADDRESS | 2012-04-16 | 8300 WEST FLAGLER STREET., 175, MIAMI, FL 33144 | No data |
| REGISTERED AGENT NAME CHANGED | 2009-04-30 | LORA, ERICK | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-29 |
| ANNUAL REPORT | 2023-04-25 |
| ANNUAL REPORT | 2022-04-29 |
| ANNUAL REPORT | 2021-04-28 |
| ANNUAL REPORT | 2020-06-29 |
| ANNUAL REPORT | 2019-04-15 |
| ANNUAL REPORT | 2018-04-30 |
| ANNUAL REPORT | 2017-04-28 |
| ANNUAL REPORT | 2016-04-29 |
| ANNUAL REPORT | 2015-04-30 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
