| Entity Name: | ADVANCED MEDICAL CLINIC, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 18 Apr 2002 (23 years ago) |
| Document Number: | P02000042272 |
| FEI/EIN Number | 010668434 |
| Address: | 3347 STATE ROAD 7, 206, WELLINGTON, FL, 33449 |
| Mail Address: | 3347 STATE ROAD 7, 206, WELLINGTON, FL, 33449 |
| ZIP code: | 33449 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1447413794 | 2008-07-08 | 2013-03-12 | 3347 STATE ROAD 7, SUITE 206, WELLINGTON, FL, 33467, US | 3347 STATE ROAD 7, SUITE 206, WELLINGTON, FL, 334498095, US | |||||||||||||||||||||||||||||||
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| Phone | +1 561-537-4820 |
| Fax | 5614343169 |
Authorized person
| Name | DR. ISHAN A GUNAWARDENE |
| Role | PRESIDENT & CEO |
| Phone | 5615374820 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | ME81674 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | FL BCBS |
| Number | 33244 |
| State | FL |
| Issuer | RR MEDICARE |
| Number | DF6667 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Vandejen Rik J | Agent | 7556 LAKE WORTH RD # 105, LAKE WORTH, FL, 33463 |
| Name | Role | Address |
|---|---|---|
| GUNAWARDENE ISHAN A | Director | 3347 STATE ROAD 7 STE 206, WELLINGTON, FL, 33449 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CANCEL ADM DISS/REV | 2003-11-20 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2003-09-19 | No data | No data |
| NAME CHANGE AMENDMENT | 2002-04-29 | ADVANCED MEDICAL CLINIC, P.A. | No data |
Date of last update: 01 Jan 2025
Sources: Florida Department of State
