| Entity Name: | SPEKTRUM HEALTH, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Non-Profit |
| Status: | Active |
| Date Filed: | 25 Oct 2018 (6 years ago) |
| Document Number: | N18000011408 |
| FEI/EIN Number | 83-2342838 |
| Address: | 5205 SOUTH ORANGE AVENUE SUITE 110, Orlando, FL, 32809, US |
| Mail Address: | 5205 south orange avenue, orlando, FL, 32809, US |
| ZIP code: | 32809 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1467921767 | 2018-11-15 | 2022-01-26 | 5205 S ORANGE AVE STE 110, ORLANDO, FL, 328093067, US | 5205 S ORANGE AVE STE 110, ORLANDO, FL, 328093067, US | |||||||||||||||||||||||||||||||||||||
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| Phone | +1 407-454-1363 |
| Fax | 3212477391 |
Authorized person
| Name | MR. JOSEPH ANTHONY KNOLL |
| Role | CEO |
| Phone | 4074541363 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | FLORIDA BLUE |
| Number | 0WDSQ |
| State | FL |
| Issuer | MEDICAID |
| Number | 015139500 |
| State | FL |
| Issuer | CIGNA |
| Number | 1061098 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| KNOLL JOSEPH | Agent | 5205 SOUTH ORANGE AVENUE SUITE 110, Orlando, FL, 32809 |
| Name | Role | Address |
|---|---|---|
| KNOLL JOSEPH | President | 5217 DRISCOLL CT., BELLE ISLE, FL, 32812 |
| Name | Role | Address |
|---|---|---|
| Hagen Kathryn | Secretary | 290 Montego Bay Ct, Merritt Island, FL, 32953 |
| Stockley Samantha | Secretary | 5205 south orange avenue, orlando, FL, 32809 |
| Name | Role | Address |
|---|---|---|
| RIOS MARITZA | Director | 3700 CLEMWOOD ST., ORLANDO, FL, 32803 |
| MORRELL TISS | Director | 2234 LAKESIDE DR., ORLANDO, FL, 32803 |
| STRAIN ROB | Director | 1487 Ridgeland Ct SW, Lilburn, GA, 30047 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2022-03-31 | 5205 SOUTH ORANGE AVENUE SUITE 110, Orlando, FL 32809 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2021-09-24 | 5205 SOUTH ORANGE AVENUE SUITE 110, Orlando, FL 32809 | No data |
| CHANGE OF MAILING ADDRESS | 2021-09-09 | 5205 SOUTH ORANGE AVENUE SUITE 110, Orlando, FL 32809 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-12 |
| ANNUAL REPORT | 2023-01-25 |
| ANNUAL REPORT | 2022-03-31 |
| ANNUAL REPORT | 2021-03-24 |
| ANNUAL REPORT | 2020-04-14 |
| ANNUAL REPORT | 2019-02-19 |
| Domestic Non-Profit | 2018-10-25 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
