| Entity Name: | ST. PETERSBURG KIDNEY CARE SOUTH, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Limited Liability Co. |
| Status: | Active |
| Date Filed: | 13 Sep 2013 (11 years ago) |
| Last Event: | LC STMNT OF RA/RO CHG |
| Event Date Filed: | 17 May 2022 (3 years ago) |
| Document Number: | M13000005807 |
| FEI/EIN Number | 46-3593263 |
| Address: | 500 Cummings Center, Suite 6550, Beverly, MA, 01915, US |
| Mail Address: | 4050 34th Street South, St. Petersburg, FL, 33711, US |
| Place of Formation: | DELAWARE |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1235549387 | 2014-04-29 | 2023-01-14 | 4050 34TH STREET SOUTH, ST PETERSBURG, FL, 337114350, US | 4050 34TH STREET SOUTH, ST PETERSBURG, FL, 337114350, US | |||||||||||||||||||||
|
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| Phone | +1 727-867-1279 |
| Fax | 7278671280 |
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 | 014094000 |
| State | FL |
| Name | Role |
|---|---|
| CORPORATION SERVICE COMPANY | Agent |
| Name | Role | Address |
|---|---|---|
| Kamal Syed T | Manager | 500 Cummings Center, Beverly, MA, 01915 |
| Fabelo Edward M.D. | Manager | 500 Cummings Center, Beverly, MA, 01915 |
| Dassani Nehal M.D. | Manager | 500 Cummings Center, Beverly, MA, 01915 |
| Mendez Nick T | Manager | 500 Cummings Center, Beverly, MA, 01915 |
| Name | Role |
|---|---|
| AMERICAN RENAL ASSOCIATES LLC | Member |
| FLY BISC LLC | Member |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G13000123956 | ST. PETERSBURG KIDNEY CENTER SOUTH | ACTIVE | 2013-12-18 | 2028-12-31 | No data | 500 CUMMINGS CENTER, SUITE 6550, BEVERLY, MA, 01915 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2024-02-23 | 500 Cummings Center, Suite 6550, Beverly, MA 01915 | No data |
| LC STMNT OF RA/RO CHG | 2022-05-17 | No data | 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 |
| CHANGE OF PRINCIPAL ADDRESS | 2021-04-17 | 500 Cummings Center, Suite 6550, Beverly, MA 01915 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-23 |
| ANNUAL REPORT | 2023-02-20 |
| CORLCRACHG | 2022-05-17 |
| ANNUAL REPORT | 2022-03-30 |
| ANNUAL REPORT | 2021-04-17 |
| ANNUAL REPORT | 2020-06-04 |
| ANNUAL REPORT | 2019-03-21 |
| ANNUAL REPORT | 2018-04-06 |
| ANNUAL REPORT | 2017-04-17 |
| ANNUAL REPORT | 2016-04-13 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
