| Entity Name: | PEDIATRIC ORTHOTIC AND PROSTHETIC SERVICES-SOUTHEAST, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Limited Liability Co. |
| Status: | Active |
| Date Filed: | 25 Jun 2012 (13 years ago) |
| Last Event: | LC NAME CHANGE |
| Event Date Filed: | 15 Jul 2014 (11 years ago) |
| Document Number: | M12000003641 |
| FEI/EIN Number | 452723185 |
| Address: | 15511 No. Florida Ave, TAMPA, FL, 33613, US |
| Mail Address: | 2900 N Rocky Point Dr, Attn: Pops Dept - Lar F., TAMPA, FL, 33607, US |
| ZIP code: | 33613 |
| County: | Hillsborough |
| Place of Formation: | DELAWARE |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1386929347 | 2011-10-20 | 2024-04-22 | PO BOX 947109, ATLANTA, GA, 303947109, US | 12502 USF PINE DR, SUITE 100, TAMPA, FL, 336129411, US | |||||||||||||||||||||||||||||
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| Phone | +1 844-602-3960 |
| Fax | 8132818461 |
| Phone | +1 813-975-7139 |
| Fax | 8136317160 |
Authorized person
| Name | MR. RONALD GINGRAS |
| Role | DIRECTOR ORTHOTICS PROSTHETICS |
| Phone | 8139757116 |
Taxonomy
| Taxonomy Code | 335E00000X - Prosthetic/Orthotic Supplier |
| License Number | 4184 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 004604300 |
| State | FL |
| Name | Role |
|---|---|
| F & L CORP. | Agent |
| Name | Role | Address |
|---|---|---|
| SHRINERS HOSPITAL FOR CHILDREN | Manager | 15511 No. Florida Ave, TAMPA, FL, 33613 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G23000097879 | SHRINERS CHILDREN'S POPS | ACTIVE | 2023-08-21 | 2028-12-31 | No data | 2900 N. ROCKY POINT DRIVE, ATTN: POPS DEPT. - LAR F., TAMPA, FL, 33607 |
| G23000097880 | SHRINERS CHILDREN'S PEDIATRIC ORTHOTIC & PROSTHETIC SERVICES | ACTIVE | 2023-08-21 | 2028-12-31 | No data | 2900 N. ROCKY POINT DRIVE, ATTN: POPS DEPT. - LAR F., TAMPA, FL, 33607 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-08-03 | 15511 No. Florida Ave, Suite 602, TAMPA, FL 33613 | No data |
| CHANGE OF MAILING ADDRESS | 2021-01-11 | 15511 No. Florida Ave, Suite 602, TAMPA, FL 33613 | No data |
| LC NAME CHANGE | 2014-07-15 | PEDIATRIC ORTHOTIC AND PROSTHETIC SERVICES-SOUTHEAST, LLC | No data |
| REGISTERED AGENT NAME CHANGED | 2014-04-18 | F & L Corp | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2014-04-18 | One Independant Drive, Suite 1300, JACKSONVILLE, FL 32202 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-08 |
| AMENDED ANNUAL REPORT | 2023-08-03 |
| ANNUAL REPORT | 2023-01-18 |
| ANNUAL REPORT | 2022-01-31 |
| ANNUAL REPORT | 2021-01-11 |
| ANNUAL REPORT | 2020-01-20 |
| ANNUAL REPORT | 2019-02-08 |
| ANNUAL REPORT | 2018-01-24 |
| ANNUAL REPORT | 2017-03-17 |
| ANNUAL REPORT | 2016-03-30 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
