| Entity Name: | PERFORMSPECIALTY, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Limited Liability Company |
| Status: | Active |
| Date Filed: | 07 Apr 2014 (11 years ago) |
| Document Number: | M14000002340 |
| FEI/EIN Number | 61-1729412 |
| Address: | 2416 Lake Orange Drive, Suite 190, Orlando, FL 32837 |
| Mail Address: | 2416 Lake Orange Drive, Suite 190, Orlando, FL 32837 |
| ZIP code: | 32837 |
| County: | Orange |
| Place of Formation: | PENNSYLVANIA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1558759266 | 2015-01-05 | 2015-01-05 | 2416 LAKE ORANGE DR, SUITE 190, ORLANDO, FL, 328377812, US | 2416 LAKE ORANGE DR, SUITE 190, ORLANDO, FL, 328377812, US | |||||||||||||||||||||||||||||||
|
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| Phone | +1 407-956-1220 |
| Fax | 4077384802 |
Authorized person
| Name | MR. ROBERT TOOTLE |
| Role | SENIOR COUNSEL |
| Phone | 2159378561 |
Taxonomy
| Taxonomy Code | 3336S0011X - Specialty Pharmacy |
| License Number | PS28204 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 012043200 |
| State | FL |
| Issuer | MEDICAID |
| Number | 1029314380001 |
| State | PA |
| Name | Role |
|---|---|
| C T CORPORATION SYSTEM | Agent |
| Name | Role | Address |
|---|---|---|
| Tootle, Robert E. | Secretary | 2416 Lake Orange Drive, Suite 190 Orlando, FL 32837 |
| Name | Role | Address |
|---|---|---|
| Kolodgy, Robert J. | Manager | 2416 Lake Orange Drive, Suite 190 Orlando, FL 32837 |
| Amstutz, Karen S. | Manager | 2416 Lake Orange Drive, Suite 190 Orlando, FL 32837 |
| Engelman, Rebecca J. | Manager | 2416 Lake Orange Drive, Suite 190 Orlando, FL 32837 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-04-04 | 2416 Lake Orange Drive, Suite 190, Orlando, FL 32837 | No data |
| CHANGE OF MAILING ADDRESS | 2024-04-04 | 2416 Lake Orange Drive, Suite 190, Orlando, FL 32837 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-04 |
| ANNUAL REPORT | 2023-02-25 |
| ANNUAL REPORT | 2022-03-24 |
| ANNUAL REPORT | 2021-04-22 |
| ANNUAL REPORT | 2020-04-21 |
| ANNUAL REPORT | 2019-03-26 |
| ANNUAL REPORT | 2018-04-03 |
| ANNUAL REPORT | 2017-04-17 |
| ANNUAL REPORT | 2016-04-12 |
| ANNUAL REPORT | 2015-04-27 |
Date of last update: 21 Feb 2025
Sources: Florida Department of State
