| Entity Name: | DEERFIELD BEACH MEDICAL CLINIC, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Domestic Profit
DEERFIELD BEACH MEDICAL CLINIC, P.A. is structured as a Domestic Profit Corporation, which, in Florida signifies a Profit Corporation (also known as a C-Corporation). This business structure is recognized as a separate legal entity from its owners. This offers shareholders the benefit of limited liability protection, safeguarding their personal assets from the corporation's debts and obligations, and facilitates raising capital through the issuance of stock. In Florida, Domestic Profit Corporations are governed by Title XXXVI, Chapter 607, Florida Statutes – Florida Business Corporation Act. |
| Status: |
Active
The business entity is active. This status indicates that the business is currently operating and compliant with state regulations, suggesting a lower risk profile for lenders and potentially better creditworthiness. |
| Date Filed: | 25 Jun 2002 (23 years ago) |
| Document Number: | P02000069715 |
| FEI/EIN Number |
043689393
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 5300 W. HILLSBORO BLVD., SUITE 216, COCONUT CREEK, FL, 33073 |
| Mail Address: | 5300 W. HILLSBORO BLVD., SUITE 216, COCONUT CREEK, FL, 33073 |
| ZIP code: | 33073 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1275732414 | 2007-07-17 | 2009-01-09 | 5300 W. HILLSBORO BLVD., SUITE 216, COCONUT CREEK, FL, 33073, US | 5300 W. HILLSBORO BLVD., SUITE 216, COCONUT CREEK, FL, 33073, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 954-725-8808 |
| Fax | 9547258818 |
Authorized person
| Name | DR. NAM QUOC NGUYEN |
| Role | PRESIDENT |
| Phone | 9547258808 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | OS0008287 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | HUMANA PROVIDER NUMBER |
| Number | 000107864 |
| Issuer | MEDICAID |
| Number | H78725 |
| State | FL |
| Issuer | MEDICAID |
| Number | 264678100 |
| State | FL |
| Issuer | BLUE CROSS BLE SHIELD PRO |
| Number | 51382 |
| State | FL |
| Issuer | NEIGBORHOOD HEALTH PROVID |
| Number | 43340 |
| Issuer | AETNA PRIVIDER NUMBER |
| Number | 145360 |
| Issuer | AVMED PROVIDER NUMBER |
| Number | 289806 |
| Issuer | OXFORD HEALTH PLANS PROVI |
| Number | P2789955 |
| Name | Role | Address |
|---|---|---|
| NGUYEN NAM Q | President | 9631 SAVONA WINDS DRIVE, DELRAY BEACH, FL, 33446 |
| NGUYEN NAM Q | Secretary | 9631 SAVONA WINDS DRIVE, DELRAY BEACH, FL, 33446 |
| NGUYEN NAM Q | Treasurer | 9631 SAVONA WINDS DRIVE, DELRAY BEACH, FL, 33446 |
| NGUYEN NAM Q | Agent | 9631 SAVONA WINDS DRIVE, DELRAY BEACH, FL, 33446 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2009-04-01 | 5300 W. HILLSBORO BLVD., SUITE 216, COCONUT CREEK, FL 33073 | - |
| CHANGE OF MAILING ADDRESS | 2009-04-01 | 5300 W. HILLSBORO BLVD., SUITE 216, COCONUT CREEK, FL 33073 | - |
| REGISTERED AGENT ADDRESS CHANGED | 2003-05-01 | 9631 SAVONA WINDS DRIVE, DELRAY BEACH, FL 33446 | - |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-21 |
| ANNUAL REPORT | 2023-03-23 |
| ANNUAL REPORT | 2022-04-20 |
| ANNUAL REPORT | 2021-04-19 |
| ANNUAL REPORT | 2020-05-01 |
| ANNUAL REPORT | 2019-03-15 |
| ANNUAL REPORT | 2018-04-20 |
| ANNUAL REPORT | 2017-07-03 |
| ANNUAL REPORT | 2016-03-29 |
| ANNUAL REPORT | 2015-04-23 |
Date of last update: 02 Apr 2025
Sources: Florida Department of State
