| Entity Name: | IMMOKALEE FAMILY DOCTOR'S CLINIC, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Florida Limited Liability Co.
IMMOKALEE FAMILY DOCTOR'S CLINIC, LLC is structured as a Limited Liability Company (LLC), a common business structure that offers its members limited liability protection, separating their personal assets from the company's debts and obligations. |
| Status: |
Active
The business entity is active. This status indicates that the business is currently operating and compliant with state regulations, suggesting a lower risk profile for lenders and potentially better creditworthiness. |
| Date Filed: | 28 Feb 1994 (31 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 19 Jul 2011 (14 years ago) |
| Document Number: | L94000000094 |
| FEI/EIN Number |
650469967
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 555 N. 15TH STREET, SUITE A, IMMOKALEE, FL, 34142, US |
| Mail Address: | 555 N. 15TH STREET, SUITE A, IMMOKALEE, FL, 34142, US |
| ZIP code: | 34142 |
| County: | Collier |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1801157839 | 2012-06-06 | 2022-04-25 | 555 N 15TH ST UNIT A, IMMOKALEE, FL, 341422824, US | 555 N 15TH ST UNIT A, IMMOKALEE, FL, 341422824, US | |||||||||||||||||||||||||
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| Phone | +1 239-657-2779 |
| Fax | 2396573335 |
Authorized person
| Name | ANDREA KEPPEL |
| Role | OFFICE MANAGER |
| Phone | 2396572779 |
Taxonomy
| Taxonomy Code | 208D00000X - General Practice Physician |
| License Number | ME42490 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 113836500 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Puerto Juan RDr. | Managing Member | 555 N. 15TH STREET, IMMOKALEE, FL, 34142 |
| PUERTO JUAN RDr. | Agent | 555 N. 15TH STREET, IMMOKALEE, FL, 34142 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2020-02-07 | PUERTO, JUAN R, Dr. | - |
| CHANGE OF PRINCIPAL ADDRESS | 2014-01-14 | 555 N. 15TH STREET, SUITE A, IMMOKALEE, FL 34142 | - |
| REGISTERED AGENT ADDRESS CHANGED | 2014-01-14 | 555 N. 15TH STREET, SUITE A, IMMOKALEE, FL 34142 | - |
| CHANGE OF MAILING ADDRESS | 2014-01-14 | 555 N. 15TH STREET, SUITE A, IMMOKALEE, FL 34142 | - |
| LC AMENDMENT | 2011-07-19 | - | - |
| LC AMENDMENT AND NAME CHANGE | 2010-04-12 | IMMOKALEE FAMILY DOCTOR'S CLINIC, LLC | - |
| CANCEL ADM DISS/REV | 2010-03-16 | - | - |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2008-09-26 | - | - |
| REINSTATEMENT | 2007-02-02 | - | - |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2006-09-15 | - | - |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J13000313024 | TERMINATED | 1000000442996 | COLLIER | 2013-01-30 | 2023-02-06 | $ 1,738.00 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, NAPLES SERVICE CENTER, 3073 HORSESHOE DR S STE 110, NAPLES FL341046145 |
| J11000237755 | TERMINATED | 1000000206815 | COLLIER | 2011-03-11 | 2021-04-20 | $ 755.57 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, NAPLES SERVICE CENTER, 3073 HORSESHOE DR S STE 110, NAPLES FL341046145 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-06 |
| ANNUAL REPORT | 2024-02-09 |
| ANNUAL REPORT | 2023-01-09 |
| ANNUAL REPORT | 2022-01-05 |
| ANNUAL REPORT | 2021-01-15 |
| ANNUAL REPORT | 2020-02-07 |
| ANNUAL REPORT | 2019-04-16 |
| ANNUAL REPORT | 2018-01-24 |
| ANNUAL REPORT | 2017-01-27 |
| ANNUAL REPORT | 2016-03-16 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 5584877700 | 2020-05-01 | 0455 | PPP | 555 N 15TH ST UNIT A, IMMOKALEE, FL, 34142-2824 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 02 Mar 2025
Sources: Florida Department of State
