| Entity Name: | MIDDLEBURG DIALYSIS LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Limited Liability Co. |
| Status: | Active |
| Date Filed: | 15 Apr 2005 (20 years ago) |
| Document Number: | M05000002003 |
| FEI/EIN Number | 01-0833118 |
| Address: | 500 CUMMINGS CENTER, SUITE 6550, BEVERLY, MA, 01915, US |
| Mail Address: | 2070 Palmetto Street Units 9, 10 and 11, Middleburg, FL, 32068, US |
| Place of Formation: | DELAWARE |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1871518670 | 2006-07-13 | 2023-01-11 | 2070 PALMETTO ST STE 9, MIDDLEBURG, FL, 320685198, US | 2070 PALMETTO ST STE 9, MIDDLEBURG, FL, 320685198, US | |||||||||||||||||||||
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| Phone | +1 904-406-5560 |
| Fax | 9044065559 |
Authorized person
| Name | SARA ANNE BRADY |
| Role | CHIEF NURSING OFFICER |
| Phone | 2083717878 |
Taxonomy
| Taxonomy Code | 261QE0700X - End-Stage Renal Disease (ESRD) Treatment Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 891397800 |
| State | FL |
| Name | Role |
|---|---|
| CORPORATION SERVICE COMPANY | Agent |
| Name | Role | Address |
|---|---|---|
| Mendez Nick | Manager | 500 CUMMINGS CENTER, BEVERLY, MA, 01915 |
| Attmore George | Manager | 500 CUMMINGS CENTER, BEVERLY, MA, 01915 |
| Kamal Syed T | Manager | 500 CUMMINGS CENTER, BEVERLY, MA, 01915 |
| Baker III James D | Manager | 500 CUMMINGS CENTER, BEVERLY, MA, 01915 |
| Name | Role | Address |
|---|---|---|
| Michal MD David Jr. | Member | 500 CUMMINGS CENTER, BEVERLY, MA, 01915 |
| AMERICAN RENAL ASSOCIATES LLC | Member | No data |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2023-02-20 | 500 CUMMINGS CENTER, SUITE 6550, BEVERLY, MA 01915 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2022-05-17 | 500 CUMMINGS CENTER, SUITE 6550, BEVERLY, MA 01915 | No data |
| REGISTERED AGENT NAME CHANGED | 2022-05-17 | CORPORATION SERVICE COMPANY | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-05-17 | 1201 HAYS STREET, TALLAHASSEE, FL 32301 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-24 |
| ANNUAL REPORT | 2024-02-23 |
| ANNUAL REPORT | 2023-02-20 |
| Reg. Agent Change | 2022-05-17 |
| ANNUAL REPORT | 2022-03-29 |
| ANNUAL REPORT | 2021-04-17 |
| ANNUAL REPORT | 2020-06-04 |
| ANNUAL REPORT | 2019-03-20 |
| ANNUAL REPORT | 2018-04-06 |
| ANNUAL REPORT | 2017-04-17 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
