| Entity Name: | LEESBURG PEDIATRICS PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 06 May 2013 (12 years ago) |
| Document Number: | P13000040370 |
| FEI/EIN Number | 46-2702638 |
| Mail Address: | 8113 CENTRALIA CT, #103, LEESBURG, FL 34788 |
| Address: | 8113 CENTRALIA CT, LEESBURG, FL 34788 |
| ZIP code: | 34788 |
| County: | Lake |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1003258666 | 2013-07-24 | 2021-12-03 | 265 CITRUS TOWER BLVD, SUITE 102, CLERMONT, FL, 347111908, US | 8113 CENTRALIA CT, LEESBURG, FL, 347887508, US | |||||||||||||||||||||||||||||
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| Phone | +1 352-394-3929 |
| Fax | 3523946446 |
| Phone | +1 352-435-7938 |
| Fax | 3528054145 |
Authorized person
| Name | MOHAMMAD AFZAL |
| Role | OWNER |
| Phone | 3523943929 |
Taxonomy
| Taxonomy Code | 208000000X - Pediatrics Physician |
| Is Primary | No |
| Taxonomy Code | 261QR1300X - Rural Health Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 009585800 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| AFZAL, MOHAMMAD | Agent | 8113 CENTRALIA CT, #103, LEESBURG, FL 34788 |
| Name | Role | Address |
|---|---|---|
| AFZAL, MOHAMMAD, DR. | Director | 265 CITRUS TOWER BLVD, #102 CLERMONT, FL 34711 |
| Name | Role | Address |
|---|---|---|
| AFZAL, MOHAMMAD, DR. | President | 265 CITRUS TOWER BLVD, #102 CLERMONT, FL 34711 |
| Name | Role | Address |
|---|---|---|
| AFZAL, NADIA | Vice President | 265 CITRUS TOWER BLVD, #102 CLERMONT, FL 34711 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2021-09-27 | 8113 CENTRALIA CT, LEESBURG, FL 34788 | No data |
| CHANGE OF MAILING ADDRESS | 2021-09-27 | 8113 CENTRALIA CT, LEESBURG, FL 34788 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-09-27 | 8113 CENTRALIA CT, #103, LEESBURG, FL 34788 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-04 |
| ANNUAL REPORT | 2023-02-05 |
| ANNUAL REPORT | 2022-01-28 |
| AMENDED ANNUAL REPORT | 2021-09-27 |
| ANNUAL REPORT | 2021-01-27 |
| ANNUAL REPORT | 2020-02-12 |
| ANNUAL REPORT | 2019-01-31 |
| ANNUAL REPORT | 2018-01-14 |
| ANNUAL REPORT | 2017-02-02 |
| ANNUAL REPORT | 2016-01-17 |
Date of last update: 22 Jan 2025
Sources: Florida Department of State
