| Entity Name: | SURAMED HEALTH CENTER PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 22 Dec 2010 (14 years ago) |
| Last Event: | NAME CHANGE AMENDMENT |
| Event Date Filed: | 31 Mar 2022 (3 years ago) |
| Document Number: | P10000102751 |
| FEI/EIN Number | 274373636 |
| Address: | 2640 FOREST HLL BLVD, PALM SPRINGS, FL, 33406, US |
| Mail Address: | 2640 FOREST HILL BLVD., PALM SPRINGS, FL, 33406, US |
| ZIP code: | 33406 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1457957896 | 2020-12-10 | 2024-08-16 | 801 MEADOWS RD STE 118, BOCA RATON, FL, 334862346, US | 801 MEADOWS RD STE 116-118, BOCA RATON, FL, 334862346, US | |||||||||||||||||||||
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| Phone | +1 561-338-9615 |
| Fax | 5613389616 |
Authorized person
| Name | DR. ALFONSO J HENRIQUEZ |
| Role | PEDIATRICIAN |
| Phone | 5613389615 |
Taxonomy
| Taxonomy Code | 208000000X - Pediatrics Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 009406904 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SILVA LINA P | Agent | 2640 FOREST HILL BLVD., PALM SPRINGS, FL, 33406 |
| Name | Role | Address |
|---|---|---|
| HENRIQUEZ ALFONSO J | President | 11683 Manatee Bay Ln, WELLINGTON, FL, 33449 |
| SILVA LINA P | President | 11683 Manatee Bay Ln, WELLINGTON, FL, 33449 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G22000018423 | SURAMED HEALTH CENTER | ACTIVE | 2022-02-14 | 2027-12-31 | No data | 3255 FOREST HILL BLVD, #107, WEST PALM BEACH, FL, 33406 |
| G18000117582 | PEDIATRIC CONSULTANTS | EXPIRED | 2018-10-31 | 2023-12-31 | No data | 3255 FOREST HILL BLVD STE 107, WEST PALM BEACH, FL, 33406 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-09-09 | 2640 FOREST HLL BLVD, PALM SPRINGS, FL 33406 | No data |
| CHANGE OF MAILING ADDRESS | 2024-09-09 | 2640 FOREST HLL BLVD, PALM SPRINGS, FL 33406 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-09-09 | 2640 FOREST HILL BLVD., PALM SPRINGS, FL 33406 | No data |
| NAME CHANGE AMENDMENT | 2022-03-31 | SURAMED HEALTH CENTER PA | No data |
| REGISTERED AGENT NAME CHANGED | 2022-03-10 | SILVA, LINA P | No data |
| AMENDMENT | 2011-04-18 | No data | No data |
| Name | Date |
|---|---|
| AMENDED ANNUAL REPORT | 2024-09-09 |
| ANNUAL REPORT | 2024-02-08 |
| ANNUAL REPORT | 2023-03-03 |
| Name Change | 2022-03-31 |
| ANNUAL REPORT | 2022-03-10 |
| ANNUAL REPORT | 2021-02-02 |
| ANNUAL REPORT | 2020-03-10 |
| ANNUAL REPORT | 2019-04-15 |
| ANNUAL REPORT | 2018-04-24 |
| ANNUAL REPORT | 2017-01-09 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
