| Entity Name: | MEDERI OF PINELLAS COUNTY, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 24 Aug 1990 (34 years ago) |
| Document Number: | L96362 |
| FEI/EIN Number | 650215831 |
| Address: | 2631 EAST OAKLAND PARK BLVD., SUITE 201, FORT LAUDERDALE, FL, 33306 |
| Mail Address: | 2631 EAST OAKLAND PARK BLVD., SUITE 201, FORT LAUDERDALE, FL, 33306 |
| ZIP code: | 33306 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1003802158 | 2005-09-23 | 2020-08-22 | 9510 ORMSBY STATION RD, SUITE 300, LOUISVILLE, KY, 402234081, US | 7800 66TH ST, SUITE 206, PINELLAS PARK, FL, 337812168, US | |||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||
| Phone | +1 502-891-1000 |
| Fax | 5028918067 |
| Phone | +1 727-546-8080 |
| Fax | 7275468010 |
Authorized person
| Name | MR. C. STEVEN GUENTHNER |
| Role | SR VP, CFO |
| Phone | 5028911000 |
Taxonomy
| Taxonomy Code | 251E00000X - Home Health Agency |
| License Number | 21923096 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS-BLUE SHIELD |
| Number | JC8 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| GALLAGHER JOHN B | Agent | 2631 EAST OAKLAND PARK BLVD., FORT LAUDERDALE, FL, 33306 |
| Name | Role | Address |
|---|---|---|
| NESSLEIN DAVID A | Secretary | 2631 EAST OAKLAND PARK BLVD., SUITE 201, FORT LAUDERDALE, FL, 33306 |
| Name | Role | Address |
|---|---|---|
| NESSLEIN DAVID A | Treasurer | 2631 EAST OAKLAND PARK BLVD., SUITE 201, FORT LAUDERDALE, FL, 33306 |
| Name | Role | Address |
|---|---|---|
| VAZQUEZ, SANDRA | President | 2631 EAST OAKLAND PARK BLVD., SUITE 201, FORT LAUDERDALE, FL, 33306 |
| Name | Role | Address |
|---|---|---|
| VAZQUEZ, SANDRA | Director | 2631 EAST OAKLAND PARK BLVD., SUITE 201, FORT LAUDERDALE, FL, 33306 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2009-09-25 | No data | No data |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
