| Entity Name: | SOUTH COUNTY ENDOCRINOLOGY, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 06 Aug 2002 (23 years ago) |
| Date of dissolution: | 24 Dec 2019 (5 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 24 Dec 2019 (5 years ago) |
| Document Number: | P02000085159 |
| FEI/EIN Number | 522372828 |
| Address: | 670 GLADES RD, SUITE 310, BOCA RATON, FL, 33431 |
| Mail Address: | 670 GLADES RD, SUITE 310, BOCA RATON, FL, 33431 |
| ZIP code: | 33431 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1659337517 | 2006-04-20 | 2008-05-20 | 670 GLADES RD, SUITE 310, BOCA RATON, FL, 334316461, US | 670 GLADES RD, SUITE 310, BOCA RATON, FL, 334316461, US | |||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 561-367-8202 |
| Fax | 5613678257 |
Authorized person
| Name | MIRTHA KELIJMAN |
| Role | PRESIDENT |
| Phone | 5613678202 |
Taxonomy
| Taxonomy Code | 207RE0101X - Endocrinology, Diabetes & Metabolism Physician |
| License Number | ME 67985 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | AVMED |
| Number | 252927 |
| State | FL |
| Issuer | BLUE CROSS BLUE SHIELD OF FLA |
| Number | 44842 |
| State | FL |
| Issuer | RAILROAD MEDICARE |
| Number | P00064212 |
| State | FL |
| Issuer | HEALTHNET |
| Number | FP0935 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| KELIJMAN MIRTHA | Agent | 670 GLADES RD, BOCA RATON, FL, 33431 |
| Name | Role | Address |
|---|---|---|
| KELIJMAN MIRTHA | President | 2000 S OCEAN BLVD APT 8C, BOCA RATON, FL, 33432 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2019-12-24 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2005-04-27 | 670 GLADES RD, SUITE 310, BOCA RATON, FL 33431 | No data |
| CHANGE OF MAILING ADDRESS | 2005-04-27 | 670 GLADES RD, SUITE 310, BOCA RATON, FL 33431 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2005-04-27 | 670 GLADES RD, SUITE 310, BOCA RATON, FL 33431 | No data |
| REGISTERED AGENT NAME CHANGED | 2003-04-23 | KELIJMAN, MIRTHA | No data |
| Name | Date |
|---|---|
| VOLUNTARY DISSOLUTION | 2019-12-24 |
| ANNUAL REPORT | 2019-02-09 |
| ANNUAL REPORT | 2018-01-14 |
| ANNUAL REPORT | 2017-01-15 |
| ANNUAL REPORT | 2016-02-27 |
| ANNUAL REPORT | 2015-01-25 |
| ANNUAL REPORT | 2014-01-12 |
| ANNUAL REPORT | 2013-02-03 |
| ANNUAL REPORT | 2012-02-19 |
| ANNUAL REPORT | 2011-01-30 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
