| Entity Name: | PHYSICIAN ASSOCIATES OF BROWARD, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 14 Oct 2004 (20 years ago) |
| Date of dissolution: | 27 Sep 2019 (5 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 27 Sep 2019 (5 years ago) |
| Document Number: | P04000142046 |
| FEI/EIN Number | 050613565 |
| Mail Address: | 5846 S Flamingo Road, Cooper City, FL, 33330, US |
| Address: | 11993 SW 47TH STREET, COOPER CITY, FL, 33330, US |
| ZIP code: | 33330 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1366723777 | 2011-08-30 | 2016-09-09 | 9900 STIRLING RD, SUITE 102, HOLLYWOOD, FL, 330248065, US | 9900 STIRLING RD, SUITE 102, HOLLYWOOD, FL, 330248065, US | |||||||||||||||||||
|
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| Phone | +1 954-322-3603 |
| Fax | 9543225303 |
Authorized person
| Name | DR. SALVADOR ENRIQUE MORA |
| Role | MEDICAL DIRECTOR |
| Phone | 9543223603 |
Taxonomy
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS |
| Number | 42635 |
| Name | Role |
|---|---|
| PANAGOS & ASSOCIATES CPAS, LLC | Agent |
| Name | Role | Address |
|---|---|---|
| MORA SALVADOR E | President | 11993 SW 47TH STREET, COOPER CITY, FL, 33330 |
| Name | Role | Address |
|---|---|---|
| MORA SALVADOR E | Secretary | 11993 SW 47TH STREET, COOPER CITY, FL, 33330 |
| Name | Role | Address |
|---|---|---|
| MORA SALVADOR E | Vice President | 11993 SW 47TH STREET, COOPER CITY, FL, 33330 |
| Name | Role | Address |
|---|---|---|
| MORA SALVADOR E | Treasurer | 11993 SW 47TH STREET, COOPER CITY, FL, 33330 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2019-09-27 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2018-03-13 | 11993 SW 47TH STREET, COOPER CITY, FL 33330 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2018-03-13 | 11993 SW 47TH STREET, COOPER CITY, FL 33330 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2014-02-17 | 2893 Executive Park Drive, Suite 102, WESTON, FL 33331 | No data |
| REGISTERED AGENT NAME CHANGED | 2014-02-17 | Panagos & Associates CPAS | No data |
| AMENDMENT | 2014-01-27 | No data | No data |
| AMENDMENT | 2013-10-21 | No data | No data |
| AMENDMENT | 2005-01-12 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2018-03-13 |
| ANNUAL REPORT | 2017-01-20 |
| ANNUAL REPORT | 2016-03-16 |
| ANNUAL REPORT | 2015-04-13 |
| ANNUAL REPORT | 2014-02-17 |
| Amendment | 2014-01-27 |
| Amendment | 2013-10-21 |
| ANNUAL REPORT | 2013-03-18 |
| ANNUAL REPORT | 2012-04-09 |
| ANNUAL REPORT | 2011-04-20 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
