| Entity Name: | B & L MEDICAL MANAGEMENT CO. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 26 May 2009 (16 years ago) |
| Date of dissolution: | 28 Sep 2012 (12 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 28 Sep 2012 (12 years ago) |
| Document Number: | P09000046242 |
| FEI/EIN Number | NOT APPLICABLE |
| Address: | 3190 S. STATE RD. 7 SUITE 12B, MIRAMAR, FL, 33023 |
| Mail Address: | 3190 S. STATE RD. 7 SUITE 12B, MIRAMAR, FL, 33023 |
| ZIP code: | 33023 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1649506569 | 2009-10-28 | 2009-10-28 | 3190 S STATE ROAD 7, SUITE 12-B, MIRAMAR, FL, 330235280, US | 3190 S STATE ROAD 7, SUITE 12-B, MIRAMAR, FL, 330235280, US | |||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||
| Phone | +1 954-961-0511 |
| Fax | 9549610519 |
Authorized person
| Name | MR. MARK E JAWAHIR |
| Role | ANESTHESIOLOGIST |
| Phone | 9549610511 |
Taxonomy
| Taxonomy Code | 207L00000X - Anesthesiology Physician |
| License Number | ME64562 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 373777200 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| HOCHMAN BRANDON | Agent | 14323 MIRAMAR PARKWAY, MIRAMAR, FL, 33027 |
| Name | Role | Address |
|---|---|---|
| WEINER LAWRENCE | President | 14323 MIRAMAR PARKWAY, MIRAMAR, FL, 33027 |
| Name | Role | Address |
|---|---|---|
| HOCHMAN BRANDON | Vice President | 14323 MIRAMAR PARKWAY, MIRAMAR, FL, 33027 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2012-09-28 | No data | No data |
| NAME CHANGE AMENDMENT | 2009-10-19 | B & L MEDICAL MANAGEMENT CO. | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2009-07-23 | 3190 S. STATE RD. 7 SUITE 12B, MIRAMAR, FL 33023 | No data |
| CHANGE OF MAILING ADDRESS | 2009-07-23 | 3190 S. STATE RD. 7 SUITE 12B, MIRAMAR, FL 33023 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2011-01-06 |
| ANNUAL REPORT | 2010-01-05 |
| Name Change | 2009-10-19 |
| ADDRESS CHANGE | 2009-07-23 |
| Domestic Profit | 2009-05-26 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
