| Entity Name: | SCIBERRAS INTERNAL MEDICINE, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Inactive |
| Date Filed: | 04 Apr 2012 (13 years ago) |
| Date of dissolution: | 22 Sep 2017 (7 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 22 Sep 2017 (7 years ago) |
| Document Number: | P12000032327 |
| FEI/EIN Number | 45-4972064 |
| Address: | 101 S. FEDERAL HWY, DANIA BEACH, FL 33004 |
| Mail Address: | 101 S. FEDERAL HWY, DANIA BEACH, FL 33004 |
| ZIP code: | 33004 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1033475900 | 2012-04-05 | 2012-05-07 | 3801 S OCEAN DR, 5F, HOLLYWOOD, FL, 330192925, US | 101 S FEDERAL HWY, DANIA BEACH, FL, 330043622, US | |||||||||||||||||||||||||||
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| Phone | +1 718-510-2561 |
| Phone | +1 954-399-9941 |
| Fax | 9543999987 |
Authorized person
| Name | DR. ANDREA SCIBERRAS |
| Role | PRESIDENT |
| Phone | 9543999941 |
Taxonomy
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| License Number | OS 9687 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 279454300 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SCIBERRAS, ANDREA | Agent | 101 S. FEDERAL HWY, DANIA BEACH, FL 33004 |
| Name | Role | Address |
|---|---|---|
| SCIBERRAS, ANDREA | President | 101 S. FEDERAL HWY, DANIA BEACH, FL 33004 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G12000038440 | DANIA BEACH MEDICAL CENTER | EXPIRED | 2012-04-23 | 2017-12-31 | No data | 101 S. FEDERAL HWY, DANIA BEACH, FL, 33004 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2017-09-22 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2014-05-07 | 101 S. FEDERAL HWY, DANIA BEACH, FL 33004 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2012-04-23 | 101 S. FEDERAL HWY, DANIA BEACH, FL 33004 | No data |
| CHANGE OF MAILING ADDRESS | 2012-04-23 | 101 S. FEDERAL HWY, DANIA BEACH, FL 33004 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2016-05-03 |
| ANNUAL REPORT | 2015-04-22 |
| ANNUAL REPORT | 2014-05-07 |
| ANNUAL REPORT | 2013-04-14 |
| Domestic Profit | 2012-04-04 |
Date of last update: 22 Feb 2025
Sources: Florida Department of State
