| Entity Name: | EXCEL PEDIATRICS & FAMILY CARE, INC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 20 Sep 2005 (19 years ago) |
| Document Number: | P05000129385 |
| FEI/EIN Number | 203498874 |
| Address: | 265 CITRUS TOWER BLVD, SUITE 102, CLERMONT, FL, 34711, US |
| Mail Address: | 265 CITRUS TOWER BLVD, SUITE 102, CLERMONT, FL, 34711, US |
| ZIP code: | 34711 |
| County: | Lake |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1871500454 | 2006-08-03 | 2015-10-26 | 265 CITRUS TOWER BLVD, 102, CLERMONT, FL, 347111908, US | 265 CITRUS TOWER BLVD, 102, CLERMONT, FL, 347111908, US | |||||||||||||||||||||||||||||
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| Phone | +1 352-394-3929 |
| Fax | 3523946446 |
Authorized person
| Name | DR. MOHAMMAD AFZAL |
| Role | DOCTOR |
| Phone | 3523943929 |
Taxonomy
| Taxonomy Code | 261QR1300X - Rural Health Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 261QU0200X - Urgent Care Clinic/Center |
| License Number | ME72542 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 660212600 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| AFZAL MOHAMMAD | Agent | 265 CITRUS TOWER BLVD, CLERMONT, FL, 34711 |
| Name | Role | Address |
|---|---|---|
| AFZAL MOHAMMAD | President | 265 CITRUS TOWER BLVD # 102, CLERMONT, FL, 34711 |
| Name | Role | Address |
|---|---|---|
| AFZAL MOHAMMAD | Director | 265 CITRUS TOWER BLVD # 102, CLERMONT, FL, 34711 |
| AFZAL NADIA | Director | 265 CITRUS TOWER BLVD # 102, CLERMONT, FL, 34711 |
| Name | Role | Address |
|---|---|---|
| AFZAL NADIA | Vice President | 265 CITRUS TOWER BLVD # 102, CLERMONT, FL, 34711 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G15000012543 | EXCEL FAMILY CARE | EXPIRED | 2015-02-04 | 2020-12-31 | No data | 265 CITRUS TOWER BLVD, SUITE 102, CLERMONT, FL, 34711 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2010-01-07 | 265 CITRUS TOWER BLVD, SUITE 102, CLERMONT, FL 34711 | No data |
| CHANGE OF MAILING ADDRESS | 2010-01-07 | 265 CITRUS TOWER BLVD, SUITE 102, CLERMONT, FL 34711 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2010-01-07 | 265 CITRUS TOWER BLVD, SUITE 102, CLERMONT, FL 34711 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-04 |
| ANNUAL REPORT | 2023-02-05 |
| ANNUAL REPORT | 2022-01-28 |
| ANNUAL REPORT | 2021-01-27 |
| ANNUAL REPORT | 2020-02-12 |
| ANNUAL REPORT | 2019-01-31 |
| ANNUAL REPORT | 2018-01-16 |
| ANNUAL REPORT | 2017-02-02 |
| ANNUAL REPORT | 2016-01-17 |
| ANNUAL REPORT | 2015-01-11 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
