| Entity Name: | AVON PARK PEDIATRICS, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 20 Jan 2009 (16 years ago) |
| Last Event: | RESTATED ARTICLES AND NAME CHANGE |
| Event Date Filed: | 16 Feb 2011 (14 years ago) |
| Document Number: | P09000005883 |
| FEI/EIN Number | 264081845 |
| Address: | 1571 U.S. HIGHWAY 27 NORTH, AVON PARK, FL, 33825, US |
| Mail Address: | 1354 STATE ROAD 60 EAST, LAKE WALES, FL, 33853, US |
| ZIP code: | 33825 |
| County: | Highlands |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1811135502 | 2009-02-03 | 2011-05-09 | 1571, U S HWY 27 N., AVON PARK, FL, 338252150, US | 1571 US HIGHWAY 27 N, AVON PARK, FL, 338252150, US | |||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||
| Phone | +1 863-453-7337 |
| Fax | 8634529790 |
Authorized person
| Name | DR. RAJESWARI S SONNI |
| Role | PRESIDENT |
| Phone | 8633820566 |
Taxonomy
| Taxonomy Code | 208000000X - Pediatrics Physician |
| Is Primary | Yes |
| Taxonomy Code | 261QR1300X - Rural Health Clinic/Center |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 001524200 |
| State | FL |
| Issuer | MEDICAID |
| Number | 000784400 |
| State | FL |
| Name | Role |
|---|---|
| DEAN MEAD SERVICES, LLC | Agent |
| Name | Role | Address |
|---|---|---|
| SONNI RAJESWARI | Director | 1571 U.S. HIGHWAY 27 NORTH, AVON PARK, FL, 33825 |
| Name | Role | Address |
|---|---|---|
| HREN LAURENCE | Administrator | 1354 STATE ROAD 60 EAST, LAKE WALES, FL, 33853 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2020-07-01 | DEAN MEAD SERVICES, LLC | No data |
| CHANGE OF MAILING ADDRESS | 2019-02-11 | 1571 U.S. HIGHWAY 27 NORTH, AVON PARK, FL 33825 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2016-12-14 | 420 S. ORANGE AVENUE, SUITE 700, ORLANDO, FL 32801 | No data |
| RESTATED ARTICLES | 2011-02-16 | No data | No data |
| RESTATED ARTICLES AND NAME CHANGE | 2011-02-16 | AVON PARK PEDIATRICS, INC. | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-19 |
| ANNUAL REPORT | 2023-04-13 |
| ANNUAL REPORT | 2022-03-03 |
| ANNUAL REPORT | 2021-03-18 |
| Reg. Agent Change | 2020-07-01 |
| ANNUAL REPORT | 2020-03-17 |
| ANNUAL REPORT | 2019-02-11 |
| ANNUAL REPORT | 2018-01-14 |
| ANNUAL REPORT | 2017-03-20 |
| Reg. Agent Change | 2016-12-14 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
