WEIRSDALE FAMILY HEALTH CENTER, INC.

Company Details

Entity Name:	WEIRSDALE FAMILY HEALTH CENTER, INC.
Jurisdiction:	FLORIDA
Filing Type:	Domestic Profit
Status:	Active
Date Filed:	15 Sep 2000 (24 years ago)
Document Number:	P00000087592
FEI/EIN Number	593670986
Address:	16400 S HWY 25, WEIRSDALE, FL, 32195
Mail Address:	PO BOX 8, WEIRSDALE, FL, 32195
ZIP code:	32195
County:	Marion
Place of Formation:	FLORIDA

NPI

Enumeration Date

Last Update Date

Mailing Address

Practice Location Address

1669548392

2006-11-27

2023-07-03

16400 S HIGHWAY 25, WEIRSDALE, FL, 321952442, US

16400 S HIGHWAY 25, WEIRSDALE, FL, 321950008, US

Contacts

Phone	+1 352-821-9797
Fax	3528210553

Authorized person

Taxonomy

Taxonomy Code	207Q00000X - Family Medicine Physician
Is Primary	No
Taxonomy Code	207R00000X - Internal Medicine Physician
Is Primary	No
Taxonomy Code	261QR1300X - Rural Health Clinic/Center
State	FL
Is Primary	Yes
Taxonomy Code	363AM0700X - Medical Physician Assistant
Is Primary	No
Taxonomy Code	363L00000X - Nurse Practitioner
Is Primary	No

Name	Role	Address
CHANG KHAI M	Agent	18550 HIGHWAY 441, MOUNT DORA, FL, 32757

Name	Role	Address
CHANG KHAI M	President	390 S. CENTRAL STREET, UMATILLA, FL, 32784

Name	Role	Address
ZAMAN WAHEEDUZ M	Secretary	390 S. CENTRAL STREET, UMATILLA, FL, 32784

Name	Role	Address
CHEEMA SHAHBAZ M	Vice President	390 S. CENTRAL STREET, UMATILLA, FL, 32784

Name	Role	Address
Patten Carl W	Auth	18550 Hwy 441, Mount Dora, FL, 32757

Event Type	Filed Date	Value	Description
AMENDMENT	2012-09-24	No data	No data

Date of last update: 01 Jan 2025