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PEDIATRIC SPECIALTY GROUP, INC.

Company Details

Entity Name: PEDIATRIC SPECIALTY GROUP, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Non-Profit
Status: Inactive
Date Filed: 29 Aug 2012 (12 years ago)
Date of dissolution: 30 Dec 2020 (4 years ago)
Last Event: CONVERSION
Event Date Filed: 30 Dec 2020 (4 years ago)
Document Number: N12000008352
FEI/EIN Number 46-3756071
Address: 3100 SW 62ND AVE., MIAMI, FL, 33155, US
Mail Address: 3100 SW 62ND AVE., MIAMI, FL, 33155, US
ZIP code: 33155
County: Miami-Dade
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1215761366 2024-08-30 2024-08-30 18503 PINES BLVD STE 212, PEMBROKE PINES, FL, 330291405, US 18503 PINES BLVD STE 212, PEMBROKE PINES, FL, 330291405, US

Contacts

Phone +1 954-392-0266

Authorized person

Name ROBBIN ANDERSON
Role CREDENTIALING SUPERVISOR
Phone 7866245747

Taxonomy

Taxonomy Code 208000000X - Pediatrics Physician
Is Primary Yes

Agent

Name Role Address
MIAMI CHILDREN'S HEALTH SYSTEM, INC C/O LE Agent 3100 SW 62ND AVE., MIAMI, FL, 33155

Chairman

Name Role Address
SOTO ALEX Chairman 3100 SW 62ND AVE., MIAMI, FL, 33155

Director

Name Role Address
LOVE MATTHEW Director 3100 SW 62ND AVE., MIAMI, FL, 33155
Dave Sandeep Director 3100 SW 62ND AVE., MIAMI, FL, 33155
Muniz Crim Alisa MD Director 3100 SW 62ND AVE., MIAMI, FL, 33155

Seni

Name Role Address
Mestre Marcos MD Seni 3100 SW 62ND AVE., MIAMI, FL, 33155

Inte

Name Role Address
Perlyn Chad MD Inte 3100 SW 62ND AVE., MIAMI, FL, 33155

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G20000018721 PEDIATRIC SPECIALISTS OF AMERICA ACTIVE 2020-02-11 2025-12-31 No data 3100 SW 62 AVENUE, MIAMI, FL, 33155
G20000018389 NICKLAUS CHILDREN'S PEDIATRIC SPECIALISTS AT CORAL SPRINGS ACTIVE 2020-02-10 2025-12-31 No data 9750 NW 33 STREET, SUITE 109,, CORAL SPRINGS, FL, 33065
G20000018382 NICKLAUS CHILDREN'S PEDIATRIC SPECIALISTS AT COCONUT CREEK ACTIVE 2020-02-10 2025-12-31 No data 6370 NORTH STATE ROAD 7, SUITE 100, COCONUT CREEK, FL, 33073
G20000016457 NICKLAUS CHILDREN'S PEDIATRIC SPECIALISTS AT ALLAPATTAH ACTIVE 2020-02-05 2025-12-31 No data 3445 NW 7 STREET, MIAMI, FL, 33125
G20000016444 NICKLAUS CHILDREN'S PEDIATRIC SPECIALISTS AT PINECREST ACTIVE 2020-02-05 2025-12-31 No data 11521 SOUTH DIXIE HIGHWAY, PINECREST, FL, 33156
G20000016432 NICKLAUS CHILDREN'S PEDIATRIC SPECIALISTS AT FLAMINGO PARK PLAZA ACTIVE 2020-02-05 2025-12-31 No data 4410 WEST 16 AVENUE BAY #60, HIALEAH, FL, 33012
G19000136800 NICKLAUS CHILDREN'S PEDIATRIC SPECIALISTS EXPIRED 2019-12-27 2024-12-31 No data 3100 SW 62 AVENUE, MIAMI, FL, 33155
G19000071302 PEDIATRIC SPECIALISTS OF AMERICA AT CORAL SPRINGS EXPIRED 2019-06-26 2024-12-31 No data 9750 NW 33RD STREET,SUITE 109,, CORAL SPRINGS, FL, 33065
G19000068907 PEDIATRIC SPECIALISTS OF AMERICA AT FLAMINGO PARK PLAZA EXPIRED 2019-06-18 2024-12-31 No data 4410 WEST 16 AVENUE BAY#60, HIALEAH, FL, 33012
G19000068896 PEDIATRIC SPECIALISTS OF AMERICA AT PINECREST EXPIRED 2019-06-18 2024-12-31 No data 11521 SOUTH DIXIE HIGHWAY, PINECREST, FL, 33155

Events

Event Type Filed Date Value Description
CONVERSION 2020-12-30 No data CONVERSION MEMBER. RESULTING CORPORATION WAS L20000396769. CONVERSION NUMBER 100000208931
REGISTERED AGENT NAME CHANGED 2019-08-14 MIAMI CHILDREN'S HEALTH SYSTEM, INC C/O LEGAL DEPT No data

Documents

Name Date
AMENDED ANNUAL REPORT 2020-09-04
ANNUAL REPORT 2020-05-13
Reg. Agent Change 2019-08-14
ANNUAL REPORT 2019-04-30
ANNUAL REPORT 2018-04-30
ANNUAL REPORT 2017-03-08
ANNUAL REPORT 2016-02-25
ANNUAL REPORT 2015-04-27
ANNUAL REPORT 2014-04-28
ANNUAL REPORT 2013-04-22

Date of last update: 01 Feb 2025

Sources: Florida Department of State