| Entity Name: | TABRAUE ORTHOPEDIC & MEDICAL SUPPLY, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 23 Jan 2002 (23 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 11 Feb 2003 (22 years ago) |
| Document Number: | P02000008422 |
| FEI/EIN Number | 800031878 |
| Address: | 106 SW 16 AVENUE, MIAMI, FL, 33135 |
| Mail Address: | 106 SW 16 AVENUE, MIAMI, FL, 33135 |
| ZIP code: | 33135 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 1538118518 | 2006-05-08 | 2016-04-12 | 106 SW 16TH AVE, MIAMI, FL, 331352116, US | 106 SW 16TH AVE, MIAMI, FL, 331352116, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 305-649-4460 |
| Fax | 3056499249 |
Authorized person
| Name | RAUL TABRAUE |
| Role | PRESIDENT |
| Phone | 3056494460 |
Taxonomy
| Taxonomy Code | 332BX2000X - Oxygen Equipment & Supplies (DME) |
| Is Primary | Yes |
| Taxonomy Code | 335E00000X - Prosthetic/Orthotic Supplier |
| License Number | ORF189 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | BOARD FRO ORTHOTIST/PROSTHETIST CERTIFICATION |
| Number | S10585 |
| State | FL |
| Issuer | AHCA |
| Number | 2025 |
| State | FL |
| Issuer | MEDICAID |
| Number | 028394100 |
| State | FL |
| Issuer | AMERIGROUP FLORIDA |
| Number | 01995024 |
| State | FL |
| Issuer | MEDICAID WAIVER |
| Number | 693458796 |
| State | FL |
| Issuer | BLUECROSS BLUESHIELD OF FLORIDA |
| Number | M2813 |
| State | FL |
| Issuer | MEDICAL OXYGEN RETAILER |
| Number | 323217 |
| State | FL |
| Issuer | MOLINA |
| Number | QMP000004742490 |
| State | FL |
| Issuer | MAGELLAN COMPLETE CARE |
| Number | MCC600932603 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| TABRAUE RAUL | Agent | 106 SW 16 AVENUE, MIAMI, FL, 33135 |
| Name | Role | Address |
|---|---|---|
| TABRAUE RAUL | President | 106 SW 16 AVE,, MIAMI, FL, 33135 |
| Name | Role | Address |
|---|---|---|
| TABRAUE RAUL | Director | 106 SW 16 AVE,, MIAMI, FL, 33135 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2014-01-06 | 106 SW 16 AVENUE, MIAMI, FL 33135 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2003-03-05 | 106 SW 16 AVENUE, MIAMI, FL 33135 | No data |
| CHANGE OF MAILING ADDRESS | 2003-03-05 | 106 SW 16 AVENUE, MIAMI, FL 33135 | No data |
| AMENDMENT | 2003-02-11 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-15 |
| ANNUAL REPORT | 2023-01-04 |
| ANNUAL REPORT | 2022-04-01 |
| ANNUAL REPORT | 2021-02-11 |
| ANNUAL REPORT | 2020-01-09 |
| ANNUAL REPORT | 2019-02-08 |
| ANNUAL REPORT | 2018-01-22 |
| ANNUAL REPORT | 2017-02-06 |
| ANNUAL REPORT | 2016-03-29 |
| ANNUAL REPORT | 2015-01-20 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
