| Entity Name: | OUR GOLDEN MEDICAL CENTER, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 02 Jul 2002 (23 years ago) |
| Document Number: | P02000072167 |
| FEI/EIN Number | 010730819 |
| Address: | 12781 BIRD ROAD, H, MIAMI, FL, 33175 |
| Mail Address: | 12781 BIRD ROAD, H, MIAMI, FL, 33175 |
| ZIP code: | 33175 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1447366208 | 2006-08-22 | 2020-08-22 | 12781 SW 42ND ST, STE H, MIAMI, FL, 331753437, US | 12781 SW 42ND ST, STE H, MIAMI, FL, 331753437, US | |||||||||||||||||||||
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| Phone | +1 305-229-3990 |
Authorized person
| Name | DIRENDIA SHACKELFORD |
| Role | MANAGED CARE SPECIALIST |
| Phone | 8006540889 |
Taxonomy
| Taxonomy Code | 332900000X - Non-Pharmacy Dispensing Site |
| License Number | ME81667 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | OTHER ID NUMBER-COMMERCIAL NUMBER |
| Number | 1019113 |
| Name | Role | Address |
|---|---|---|
| GONZALEZ AVELINO J | Agent | 6780 CORAL WAY LAW CENTER, MIAMI, FL, 33155 |
| Name | Role | Address |
|---|---|---|
| CASTRO MAYRA | Director | 12781 BIRD ROAD STE H, MIAMI, FL, 33175 |
| CAMAYD JUAN G | Director | 12781 BIRD ROAD STE H, MIAMI, FL, 33175 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2009-09-25 | No data | No data |
Date of last update: 02 Jan 2025
Sources: Florida Department of State
