| Entity Name: | HERNANDO MEDICAL, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 09 Jan 2004 (21 years ago) |
| Document Number: | P04000009477 |
| FEI/EIN Number | 200597474 |
| Address: | 12900 CORTEZ BLVD, SUITE 202, BROOKSVILLE, FL, 34613 |
| Mail Address: | 12900 CORTEZ BLVD, SUITE 202, BROOKSVILLE, FL, 34613 |
| ZIP code: | 34613 |
| County: | Hernando |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1023080629 | 2006-02-07 | 2009-12-09 | 12900 CORTEZ BLVD, STE 202, BROOKSVILLE, FL, 34613, US | 12900 CORTEZ BLVD, STE 202, BROOKSVILLE, FL, 34613, US | |||||||||||||||||||||||||
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| Phone | +1 352-597-8844 |
| Fax | 3525978831 |
Authorized person
| Name | MOHAMMAD A JOUD |
| Role | PRESIDENT OWNER |
| Phone | 3525978844 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | ME78544 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 258942700 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| JOUD MOHAMMAD A | Agent | 12900 CORTEZ BLVD, BROOKSVILLE, FL, 34613 |
| Name | Role | Address |
|---|---|---|
| JOUD MOHAMMAD A | President | 12900 CORTEZ BLVD., SUITE 202, BROOKSVILLE, FL, 34613 |
| Name | Role | Address |
|---|---|---|
| JOUD MOHAMMAD A | Secretary | 12900 CORTEZ BLVD., SUITE 202, BROOKSVILLE, FL, 34613 |
| Name | Role | Address |
|---|---|---|
| JOUD MOHAMMAD A | Treasurer | 12900 CORTEZ BLVD., SUITE 202, BROOKSVILLE, FL, 34613 |
| Name | Role | Address |
|---|---|---|
| JOUD MOHAMMAD A | Director | 12900 CORTEZ BLVD., SUITE 202, BROOKSVILLE, FL, 34613 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2006-01-10 | 12900 CORTEZ BLVD, SUITE 202, BROOKSVILLE, FL 34613 | No data |
| CHANGE OF MAILING ADDRESS | 2006-01-10 | 12900 CORTEZ BLVD, SUITE 202, BROOKSVILLE, FL 34613 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2006-01-10 | 12900 CORTEZ BLVD, SUITE 202, BROOKSVILLE, FL 34613 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-03 |
| ANNUAL REPORT | 2023-02-18 |
| ANNUAL REPORT | 2022-02-05 |
| ANNUAL REPORT | 2021-01-18 |
| ANNUAL REPORT | 2020-01-21 |
| ANNUAL REPORT | 2019-02-14 |
| ANNUAL REPORT | 2018-01-14 |
| ANNUAL REPORT | 2017-01-06 |
| ANNUAL REPORT | 2016-03-21 |
| ANNUAL REPORT | 2015-02-08 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
