| Entity Name: | ROYAL PALM ORTHOPEDIC & SPORTS MEDICINE INSTITUTE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Limited Liability Co. |
| Status: | Active |
| Date Filed: | 20 Dec 2007 (17 years ago) |
| Document Number: | M07000007411 |
| FEI/EIN Number | 753257037 |
| Mail Address: | 23781 US HWY 27, Lake Wales, FL, 33859, US |
| Address: | 1120 CARLTON AVE, SUITE 1400, LAKE WALES, FL, 33853 |
| ZIP code: | 33853 |
| County: | Polk |
| Place of Formation: | DELAWARE |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1538644349 | 2018-09-27 | 2023-03-17 | 23781 US HIGHWAY 27 STE 122, LAKE WALES, FL, 338597802, US | 575 E CENTRAL AVE, WINTER HAVEN, FL, 338803054, US | |||||||||||||||||||
|
|||||||||||||||||||||||
| Phone | +1 863-324-6100 |
Authorized person
| Name | DAVID ARANGO |
| Role | OWNER |
| Phone | 8633246100 |
Taxonomy
| Taxonomy Code | 207X00000X - Orthopaedic Surgery Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 280899400 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Marquez Vivian | Agent | 1120 CARLTON AVE, LAKE WALES, FL, 33853 |
| Name | Role | Address |
|---|---|---|
| Arango David MD | Administrator | 1120 CARLTON AVE, LAKE WALES, FL, 33853 |
| Name | Role | Address |
|---|---|---|
| Marquez Vivian | Auth | 1120 CARLTON AVE, LAKE WALES, FL, 33853 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2023-01-20 | Marquez, Vivian | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2017-01-17 | 1120 CARLTON AVE, SUITE 1400, LAKE WALES, FL 33853 | No data |
| CHANGE OF MAILING ADDRESS | 2013-04-03 | 1120 CARLTON AVE, SUITE 1400, LAKE WALES, FL 33853 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2012-01-05 | 1120 CARLTON AVE, SUITE 1400, LAKE WALES, FL 33853 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-05 |
| ANNUAL REPORT | 2023-01-20 |
| ANNUAL REPORT | 2022-01-27 |
| AMENDED ANNUAL REPORT | 2021-02-22 |
| ANNUAL REPORT | 2021-01-31 |
| ANNUAL REPORT | 2020-01-27 |
| ANNUAL REPORT | 2019-01-27 |
| ANNUAL REPORT | 2018-01-13 |
| ANNUAL REPORT | 2017-01-17 |
| ANNUAL REPORT | 2016-01-25 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
