| Entity Name: | SAVICO MEDICAL ASSOCIATES INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 29 Jun 2004 (21 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 17 Dec 2012 (12 years ago) |
| Document Number: | P04000098555 |
| FEI/EIN Number | 55-0873886 |
| Address: | 17439 NW 66 COURT, HIALEAH, FL 33015 |
| Mail Address: | 17439 NW 66 COURT, HIALEAH, FL 33015 |
| ZIP code: | 33015 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1154611036 | 2011-04-13 | 2016-12-30 | 17439 NW 66TH CT, HIALEAH, FL, 330154431, US | 18356 NW 47TH AVE, MIAMI GARDENS, FL, 330552934, US | |||||||||||||||||||||||||
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| Phone | +1 305-974-5750 |
| Fax | 3057574443 |
Authorized person
| Name | DR. COMFORT OMOBOLA ADEWUMI |
| Role | PRESIDENT/PHYSICIAN DIRECTOR/OWNER |
| Phone | 3057574442 |
Taxonomy
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| License Number | OS8579 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 275310300 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| LEBLANC, GAIL | Agent | 17447 NW 66 CT., MIAMI, FL 33015 |
| Name | Role | Address |
|---|---|---|
| ADEWUMI, COMFORT | President | 17439 NW 66 COURT, HIALEAH, FL 33015 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2019-08-29 | 17439 NW 66 COURT, HIALEAH, FL 33015 | No data |
| CHANGE OF MAILING ADDRESS | 2019-08-29 | 17439 NW 66 COURT, HIALEAH, FL 33015 | No data |
| AMENDMENT | 2012-12-17 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-08 |
| ANNUAL REPORT | 2023-02-20 |
| ANNUAL REPORT | 2022-04-10 |
| ANNUAL REPORT | 2021-03-31 |
| ANNUAL REPORT | 2020-03-16 |
| ANNUAL REPORT | 2019-08-29 |
| ANNUAL REPORT | 2018-04-29 |
| ANNUAL REPORT | 2017-04-24 |
| ANNUAL REPORT | 2016-05-01 |
| ANNUAL REPORT | 2015-04-30 |
Date of last update: 29 Jan 2025
Sources: Florida Department of State
