| Entity Name: | INGRAM PEDIATRICS, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 06 Apr 2006 (19 years ago) |
| Document Number: | P06000049570 |
| FEI/EIN Number | 204642093 |
| Address: | 4100 SOUTH HOSPITAL DRIVE, SUITE 302, PLANTATION, FL, 33317, US |
| Mail Address: | 4100 SOUTH HOSPITAL DRIVE, SUITE 302, PLANTATION, FL, 33317, US |
| ZIP code: | 33317 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1265581383 | 2007-01-09 | 2022-06-16 | 4100 SOUTH HOSPITAL DRIVE, SUITE 302, PLANTATION, FL, 333172838, US | 4101 S HOSPITAL DR, SUITE 12, PLANTATION, FL, 333172857, US | |||||||||||||||||||||||||
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| Phone | +1 954-321-1591 |
| Fax | 9543211592 |
Authorized person
| Name | DR. DEBORAH E INGRAM |
| Role | PHYSICIAN/OWNER |
| Phone | 9543211591 |
Taxonomy
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| License Number | ME79116 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 261906700 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| WALKER GARY E | Agent | 401 East Jackson Street, TAMPA, FL, 33602 |
| Name | Role | Address |
|---|---|---|
| INGRAM DEBORAH E | President | 4100 SOUTH HOSPITAL DRIVE, SUITE 302, PLANTATION, FL, 33317 |
| Name | Role | Address |
|---|---|---|
| Ingram Carrie | Exec | 4100 SOUTH HOSPITAL DRIVE, PLANTATION, FL, 33317 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2019-03-27 | 401 East Jackson Street, SUITE 3100, TAMPA, FL 33602 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2014-03-30 | 4100 SOUTH HOSPITAL DRIVE, SUITE 302, PLANTATION, FL 33317 | No data |
| CHANGE OF MAILING ADDRESS | 2014-03-30 | 4100 SOUTH HOSPITAL DRIVE, SUITE 302, PLANTATION, FL 33317 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-04 |
| ANNUAL REPORT | 2023-03-10 |
| ANNUAL REPORT | 2022-04-11 |
| ANNUAL REPORT | 2021-03-13 |
| ANNUAL REPORT | 2020-05-07 |
| ANNUAL REPORT | 2019-03-27 |
| ANNUAL REPORT | 2018-03-09 |
| ANNUAL REPORT | 2017-04-09 |
| ANNUAL REPORT | 2016-04-10 |
| ANNUAL REPORT | 2015-02-18 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
