| Entity Name: | LEGION PARK MEDICAL CENTER, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 20 Dec 1984 (40 years ago) |
| Document Number: | M09202 |
| FEI/EIN Number | 592482089 |
| Address: | 6630 BISCAYNE BLVD, MIAMI, FL, 33168 |
| Mail Address: | 6630 BISCAYNE BLVD, MIAMI, FL, 33168 |
| ZIP code: | 33168 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1134312770 | 2007-08-27 | 2007-08-27 | 6630 BISCAYNE BLVD, MIAMI, FL, 331386217, US | 6630 BISCAYNE BLVD, MIAMI, FL, 331386217, US | |||||||||||||||||||||||
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| Phone | +1 305-754-8966 |
Authorized person
| Name | MRS. LAURA A ELIZEE |
| Role | OFFICE ADMINISTRATOR |
| Phone | 3057548966 |
Taxonomy
| Taxonomy Code | 305R00000X - Preferred Provider Organization |
| License Number | HCC6998 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICARE PROVIDER # |
| Number | K6954 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| IKPE HELEN | Agent | 6630 BISCAYNE BLVD, MIAMI, FL, 33168 |
| Name | Role | Address |
|---|---|---|
| IKPE HELEN | President | 6630 BISCAYNE BLVD, MIAMI, FL, 33168 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2009-09-25 | No data | No data |
| CANCEL ADM DISS/REV | 2005-12-12 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2005-09-16 | No data | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J02000132153 | LAPSED | 01-12262-SP-26-01 | MIAMI-DADE COUNTY COURT | 2002-03-08 | 2007-04-04 | $213.52 | ABC COMMUNICATIONS CORP., 16500 NW 52ND AVENUE, MIAMI, FL 33014 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
