| Entity Name: | FAMILY FIRST MEDICAL PHYSICIANS, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Limited Liability Company |
| Status: | Active |
| Date Filed: | 06 Apr 2021 (4 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 12 Oct 2021 (3 years ago) |
| Document Number: | M21000003929 |
| FEI/EIN Number | 86-3038925 |
| Address: | 425 W. COLONIAL DR., STE 303, Orlando, FL 32804 |
| Mail Address: | 425 W. COLONIAL DR., STE 303, Orlando, FL 32804 |
| ZIP code: | 32804 |
| County: | Orange |
| Place of Formation: | DELAWARE |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1043985161 | 2021-08-11 | 2021-08-11 | 33044 HWY 27, HAINES CITY, FL, 338447621, US | 33044 HWY 27, HAINES CITY, FL, 338447621, US | |||||||||||||||
|
|||||||||||||||||||
| Phone | +1 863-422-4977 |
| Fax | 8634227786 |
Authorized person
| Name | DWIGHT PEREZ |
| Role | CREDENTIALING SPECIALIST |
| Phone | 3057335713 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
| Name | Role |
|---|---|
| C T CORPORATION SYSTEM | Agent |
| Name | Role | Address |
|---|---|---|
| Malton, Douglas | Manager | 6900 Tavistock Lakes Blvd., Suite 300 Orlando, FL 32827 |
| Abbott, Will | Manager | 6900 Tavistock Lakes Blvd., Suite 300 Orlando, FL 32827 |
| Shinto, Richard A., M.D. | Manager | 6900 Tavistock Lakes Blvd., Suite 300 Orlando, FL 32827 |
| Name | Role |
|---|---|
| TRINITY MEDICAL ACQUISITION, LLC | Sole Member |
| Name | Role | Address |
|---|---|---|
| Abbott, Will | Chief Operating Officer | 6900 Tavistock Lakes Blvd., Suite 300 Orlando, FL 32827 |
| Ravi, Chari | Chief Operating Officer | 6900 Tavistock Lakes Blvd., Suite 300 Orlando, FL 32827 |
| Name | Role | Address |
|---|---|---|
| Brown, David | Secretary | 6900 Tavistock Lakes Blvd., Suite 300 Orlando, FL 32827 |
| Name | Role | Address |
|---|---|---|
| Malton, Douglas | Vice President | 6900 Tavistock Lakes Blvd., Suite 300 Orlando, FL 32827 |
| Name | Role | Address |
|---|---|---|
| Malton, Douglas | Chief Financial Officer | 6900 Tavistock Lakes Blvd., Suite 300 Orlando, FL 32827 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G21000104201 | VIVIFI AESTHECTIC CLINIC | ACTIVE | 2021-08-11 | 2026-12-31 | No data | 44 SOUTH BROADWAY, 1ST FLOOR, WHITE PLAINS, NY, 10601 |
| G21000081417 | FAMILY FIRST MEDICAL CENTER | ACTIVE | 2021-06-18 | 2026-12-31 | No data | 425 W COLONIAL DRIVE STE 303, ORLANDO, FL, 32804 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2025-01-03 | 425 W. COLONIAL DR., STE 303, Orlando, FL 32804 | No data |
| CHANGE OF MAILING ADDRESS | 2025-01-03 | 425 W. COLONIAL DR., STE 303, Orlando, FL 32804 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2024-04-24 | 6900 Tavistock Lakes Blvd., Suite 300, Orlando, FL 32827 | No data |
| CHANGE OF MAILING ADDRESS | 2024-04-24 | 6900 Tavistock Lakes Blvd., Suite 300, Orlando, FL 32827 | No data |
| LC AMENDMENT | 2021-10-12 | No data | No data |
| LC AMENDMENT | 2021-04-08 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-03 |
| ANNUAL REPORT | 2024-04-24 |
| AMENDED ANNUAL REPORT | 2023-12-06 |
| AMENDED ANNUAL REPORT | 2023-09-11 |
| AMENDED ANNUAL REPORT | 2023-09-08 |
| AMENDED ANNUAL REPORT | 2023-08-23 |
| ANNUAL REPORT | 2023-01-26 |
| ANNUAL REPORT | 2022-02-14 |
| LC Amendment | 2021-10-12 |
| LC Amendment | 2021-04-08 |
Date of last update: 14 Jan 2025
Sources: Florida Department of State
