| Entity Name: | ZANNIS FAMILY MEDICAL CENTER, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 02 Apr 2002 (23 years ago) |
| Document Number: | P02000035648 |
| FEI/EIN Number | 043648281 |
| Address: | 2644 E. Oakland Park Blvd., Fort Lauderdale, FL, 33306, US |
| Mail Address: | 2644 E. Oakland Park Blvd., Fort Lauderdale, FL, 33306, US |
| ZIP code: | 33306 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1285755405 | 2007-04-03 | 2011-08-16 | 1500 N UNIVERSITY DR STE 112, CORAL SPRINGS, FL, 330716071, US | 1500 N UNIVERSITY DR STE 112, CORAL SPRINGS, FL, 330716071, US | |||||||||||||||||||||||
|
|||||||||||||||||||||||||||
| Phone | +1 954-346-3120 |
Authorized person
| Name | DR. JASON MATTHEW ZANNIS |
| Role | DOCTER |
| Phone | 9543463120 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | OS8070 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 264476200 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| ZANNIS JASON | Agent | 2644 E Oakland Park Blvd, Fort Lauderdale, FL, 33306 |
| Name | Role | Address |
|---|---|---|
| ZANNIS JASON M | President | 1500 N UNIVERSITY DR, Coral Springs, FL, 33071 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G23000051961 | WALK-IN TO WELLNESS | ACTIVE | 2023-04-24 | 2028-12-31 | No data | 2644 E OAKLAND PARK BLVD, FT LAUDERDALE, FL, 33306 |
| G16000133903 | WALK-IN TO WELLNESS | EXPIRED | 2016-12-13 | 2021-12-31 | No data | 1500 N UNIVERSITY DRIVE #112, CORAL SPRINGS, FL, 33071 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2023-10-04 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2023-09-22 | No data | No data |
| REINSTATEMENT | 2019-11-04 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2019-09-27 | No data | No data |
| REINSTATEMENT | 2018-10-31 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2018-09-28 | No data | No data |
| REINSTATEMENT | 2017-10-02 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2017-09-22 | No data | No data |
| CANCEL ADM DISS/REV | 2007-10-22 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2007-09-14 | No data | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J07000174733 | TERMINATED | 1000000051738 | 44115 468 | 2007-05-31 | 2027-06-06 | $ 3,572.41 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, HOLLYWOOD SERVICE CENTER, 6565 TAFT ST STE 300, HOLLYWOOD FL330244044 |
Date of last update: 03 Jan 2025
Sources: Florida Department of State
