| Entity Name: | BROWARD MEDICAL & URGENT CARE, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 29 May 2001 (24 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 01 Dec 2023 (a year ago) |
| Document Number: | P01000055597 |
| FEI/EIN Number | 651135943 |
| Address: | 103 SE 20 ST, FT LAUDERDALE, FL, 33316 |
| Mail Address: | 103 SE 20 ST, FT LAUDERDALE, FL, 33316 |
| ZIP code: | 33316 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1447465547 | 2007-05-11 | 2014-07-15 | 103 SE 20TH ST, SUITE 100, FT LAUDERDALE, FL, 333162846, US | 103 SE 20TH ST, FT LAUDERDALE, FL, 333162846, US | |||||||||||||||||||||||||||||||||||||||
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| Phone | +1 954-462-7558 |
| Fax | 9545255820 |
Authorized person
| Name | MARTIN M ROCHE |
| Role | MEDICAL DIRECTOR |
| Phone | 9544627558 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| License Number | ME13408 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 261QU0200X - Urgent Care Clinic/Center |
| License Number | ME13408 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS OF FLORIDA |
| Number | 06962 |
| State | FL |
| Issuer | PTAN MEDICARE |
| Number | AD067Y |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Ashling M Roche, PA | Agent | 103 SE 20 ST, FT LAUDERDALE, FL, 33316 |
| Name | Role | Address |
|---|---|---|
| Roche Martin M M | President | 103 SE 20th Street, Fort Lauderdale, FL, 33316 |
| Name | Role | Address |
|---|---|---|
| Roche Martin M M | Director | 103 SE 20th Street, Fort Lauderdale, FL, 33316 |
| Name | Role | Address |
|---|---|---|
| Amiel Ashling | Vice President | 103 SE 20 ST, FT LAUDERDALE, FL, 33316 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2023-12-01 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2023-12-01 | Ashling M Roche, PA | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2023-09-22 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2012-04-01 | 103 SE 20 ST, FT LAUDERDALE, FL 33316 | No data |
| CHANGE OF MAILING ADDRESS | 2012-04-01 | 103 SE 20 ST, FT LAUDERDALE, FL 33316 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2012-04-01 | 103 SE 20 ST, 100, FT LAUDERDALE, FL 33316 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-25 |
| REINSTATEMENT | 2023-12-01 |
| ANNUAL REPORT | 2022-03-16 |
| ANNUAL REPORT | 2021-05-01 |
| ANNUAL REPORT | 2020-03-15 |
| ANNUAL REPORT | 2019-02-20 |
| ANNUAL REPORT | 2018-02-12 |
| ANNUAL REPORT | 2017-02-26 |
| ANNUAL REPORT | 2016-03-09 |
| ANNUAL REPORT | 2015-04-28 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
