| Entity Name: | FALCON MEDICAL GROUP INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 26 Apr 2007 (18 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 26 Oct 2022 (2 years ago) |
| Document Number: | P07000051335 |
| FEI/EIN Number | 113812755 |
| Address: | 6000 METROWEST BLVD, ORLANDO, FL, 32835, US |
| Mail Address: | 6000 METROWEST BLVD, ORLANDO, FL, 32835, US |
| ZIP code: | 32835 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1700078979 | 2007-08-13 | 2024-07-16 | 6000 METROWEST BLVD, SUITE 104, ORLANDO, FL, 328357630, US | 6000 METROWEST BLVD STE 104, ORLANDO, FL, 328357630, US | |||||||||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 407-365-3033 |
| Fax | 4073653034 |
Authorized person
| Name | DR. JAIVIR S RATHORE |
| Role | OWNER |
| Phone | 2169252499 |
Taxonomy
| Taxonomy Code | 207RS0012X - Sleep Medicine (Internal Medicine) Physician |
| License Number | ME 102387 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 2084E0001X - Epilepsy Physician |
| Is Primary | Yes |
| Taxonomy Code | 2084N0400X - Neurology Physician |
| License Number | ME 102387 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 000042800 |
| State | FL |
| Issuer | MEDICAID |
| Number | 104167800 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SINGH RATHORE JAIVIR MD | Agent | 6000 METROWEST BLVD., ORLANDO, FL, 32835 |
| Name | Role | Address |
|---|---|---|
| SINGH RATHORE JAIVIR MD | President | 6000 METROWEST BLVD 104-105, ORLANDO, FL, 32835 |
| Name | Role | Address |
|---|---|---|
| SINGH RATHORE JAIVIR MD | Chief Executive Officer | 6000 METROWEST BLVD 104-105, ORLANDO, FL, 32835 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G22000049296 | FALCON ADVANCED NEUROLOGY | ACTIVE | 2022-04-18 | 2027-12-31 | No data | 6000 METROWEST BLVD, STE-104, ORLANDO, FL, 32835 |
| G21000093658 | FALCON ADVANCED NEUROLOGY | ACTIVE | 2021-07-17 | 2026-12-31 | No data | 6000 METROWEST BLVD, STE-104, ORLANDO, FL, 32835 |
| G14000037185 | FALCON SLEEP AND NEURODIAGNOSTICS | ACTIVE | 2014-04-15 | 2025-12-31 | No data | 6000 METROWEST BLVD., # 4, ORLANDO, FL, 32835 |
| G13000092612 | FALCON SLEEP CENTER | EXPIRED | 2013-09-18 | 2018-12-31 | No data | 120 ALEXANDRIA BLVD, SUITE 19, OVIEDO, FL, 32765 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2023-04-29 | 6000 METROWEST BLVD, 104-105, ORLANDO, FL 32835 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2023-04-29 | 6000 METROWEST BLVD, 104-105, ORLANDO, FL 32835 | No data |
| REGISTERED AGENT NAME CHANGED | 2022-10-26 | SINGH RATHORE, JAIVIR, MD | No data |
| AMENDMENT | 2022-10-26 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-10-26 | 6000 METROWEST BLVD., STE 104-105, ORLANDO, FL 32835 | No data |
| AMENDMENT | 2022-09-15 | No data | No data |
| AMENDMENT | 2021-07-14 | No data | No data |
| AMENDMENT | 2021-07-07 | No data | No data |
| AMENDMENT | 2020-10-06 | No data | No data |
| AMENDMENT | 2020-06-22 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-03 |
| ANNUAL REPORT | 2023-04-29 |
| Amendment | 2022-10-26 |
| Amendment | 2022-09-15 |
| ANNUAL REPORT | 2022-04-18 |
| Amendment | 2021-07-14 |
| Amendment | 2021-07-07 |
| ANNUAL REPORT | 2021-04-18 |
| Amendment | 2020-10-06 |
| Amendment | 2020-06-22 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
