| Entity Name: | PREMIER FAMILY AND PALLIATIVE MEDICAL CENTER, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 01 Jul 2010 (15 years ago) |
| Date of dissolution: | 27 Sep 2013 (11 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 27 Sep 2013 (11 years ago) |
| Document Number: | P10000055064 |
| FEI/EIN Number | 272966891 |
| Address: | 1 W. SAMPLE RD., #104, POMPANO BEACH, FL, 33064, US |
| Mail Address: | 3410 NW 110 TERRACE, CORAL SPRINGS, FL, 33065, US |
| ZIP code: | 33064 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1679889968 | 2010-08-24 | 2011-01-06 | 1 W SAMPLE RD, SUITE 104, POMPANO BEACH, FL, 330643547, US | 1 W SAMPLE RD # 3104, POMPANO BEACH, FL, 330643547, US | |||||||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 954-782-2802 |
| Fax | 9547822881 |
Authorized person
| Name | LAURA BURKE |
| Role | MCC |
| Phone | 9547822802 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | OS10256 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 207QH0002X - Hospice and Palliative Medicine (Family Medicine) Physician |
| License Number | OS10256 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 208VP0000X - Pain Medicine Physician |
| License Number | OS10256 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 001156200 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| LIBBY DENISE | Agent | 3410 NW 110 TERRACE, CORAL SPRINGS, FL, 33065 |
| Name | Role | Address |
|---|---|---|
| NEWMAN SHERIKA | President | 4174 INVERRARY DR. #512, LAUDERHILL, FL, 33319 |
| Name | Role | Address |
|---|---|---|
| NEWMAN SHERIKA | Vice President | 4174 INVERRARY DR. #512, LAUDERHILL, FL, 33319 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2013-09-27 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2012-01-06 | 1 W. SAMPLE RD., #104, POMPANO BEACH, FL 33064 | No data |
| CHANGE OF MAILING ADDRESS | 2012-01-06 | 1 W. SAMPLE RD., #104, POMPANO BEACH, FL 33064 | No data |
| NAME CHANGE AMENDMENT | 2010-07-12 | PREMIER FAMILY AND PALLIATIVE MEDICAL CENTER, INC. | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2012-01-06 |
| ANNUAL REPORT | 2011-01-06 |
| Name Change | 2010-07-12 |
| Domestic Profit | 2010-07-01 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
