| Entity Name: | SUNCOAST PROVIDER NETWORK, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 26 Jun 2007 (18 years ago) |
| Document Number: | P07000073993 |
| FEI/EIN Number | 26-0428714 |
| Mail Address: | 9780 E INDIGO STREET, SUITE 202, PALMETTO BAY, FL 33157 |
| Address: | 10621 NORTH KENDALL DR, SUITE 211, MIAMI, FL 33176 |
| ZIP code: | 33176 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1679013130 | 2017-03-03 | 2017-03-03 | 10621 N KENDALL DR, SUITE 211, MIAMI, FL, 331768708, US | 10621 N KENDALL DR, SUITE 211, MIAMI, FL, 331768708, US | |||||||||||||||
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| Phone | +1 305-596-4288 |
| Fax | 7865159378 |
Authorized person
| Name | MR. RENE F GOMEZ |
| Role | CEO |
| Phone | 3055964288 |
Taxonomy
| Taxonomy Code | 302F00000X - Exclusive Provider Organization |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| LEVY, RAYMOND | Agent | 9780 E INDIGO STREET, SUITE 202, PALMETTO BAY, FL 33157 |
| Name | Role | Address |
|---|---|---|
| GOMEZ, RENE F | Chief Executive Officer | 10621 NORTH KENDALL DR #211, MIAMI, FL 33176 |
| Name | Role | Address |
|---|---|---|
| IGLESIAS, MRS MIRIAM A | Executive Vice President | 10621 NORTH KENDALL DR #211, MIAMI, FL 33176 |
| Name | Role | Address |
|---|---|---|
| LEVY, RAYMOND | Chief Operating Officer | 9780 E indigo Street, #202 Palmetto Bay, FL 33157 |
| Name | Role | Address |
|---|---|---|
| MARTINEZ, HENRIETTA | Chief Financial Officer | 9780 E INDIGO STREET, SUITE 202 PALMETTO BAY, FL 33157 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2024-01-16 | 10621 NORTH KENDALL DR, SUITE 211, MIAMI, FL 33176 | No data |
| REGISTERED AGENT NAME CHANGED | 2024-01-16 | LEVY, RAYMOND | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-01-16 | 9780 E INDIGO STREET, SUITE 202, PALMETTO BAY, FL 33157 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2009-04-21 | 10621 NORTH KENDALL DR, SUITE 211, MIAMI, FL 33176 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-16 |
| ANNUAL REPORT | 2023-01-23 |
| ANNUAL REPORT | 2022-01-13 |
| ANNUAL REPORT | 2021-05-03 |
| ANNUAL REPORT | 2020-01-23 |
| ANNUAL REPORT | 2019-02-01 |
| ANNUAL REPORT | 2018-01-12 |
| ANNUAL REPORT | 2017-01-09 |
| ANNUAL REPORT | 2016-01-25 |
| ANNUAL REPORT | 2015-01-09 |
Date of last update: 01 Jan 2025
Sources: Florida Department of State
