| Entity Name: | BROWARD HEALTH MEDICAL GROUP, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 14 Oct 2013 (11 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 08 Jul 2021 (4 years ago) |
| Document Number: | P13000084112 |
| FEI/EIN Number | NOT APPLICABLE |
| Address: | 7539-41 WEST OAKLAND PARK BLVD, LAUDERHILL, FL, 33319, US |
| Mail Address: | 7539-41 WEST OAKLAND PARK BLVD, LAUDERHILL, FL, 33319, US |
| ZIP code: | 33319 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1568197994 | 2022-07-20 | 2023-01-17 | 7539 W OAKLAND PARK BLVD STE 41, TAMARAC, FL, 333194909, US | 7539 W OAKLAND PARK BLVD, TAMARAC, FL, 333194909, US | |||||||||||||||
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| Phone | +1 754-223-2705 |
| Fax | 7542232836 |
Authorized person
| Name | DR. SHANNA STEPHEN |
| Role | MEDICAL DIRECTOR |
| Phone | 7542232705 |
Taxonomy
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| AMISIAL JEAN MDr. | Agent | 7539-41 WEST OAKLAND PARK BLVD, LAUDERHILL, FL, 33319 |
| Name | Role | Address |
|---|---|---|
| AMISIAL JEAN M | President | 6415 Osprey Landing St., DAVID, FL, 33314 |
| Name | Role | Address |
|---|---|---|
| SANOZIER ROCK | Manager | 4770 NW 9TH CT, PLANTATION, FL, 33317 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G22000079178 | CENTRIC FAMILY MED & REHAB | ACTIVE | 2022-07-01 | 2027-12-31 | No data | 5979 VINELAND ROAD, SUITE 214, ORLANDO FL, FL, 32819 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2023-09-12 | AMISIAL, JEAN MICHEL, Dr. | No data |
| REINSTATEMENT | 2021-07-08 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2021-07-08 | 7539-41 WEST OAKLAND PARK BLVD, LAUDERHILL, FL 33319 | No data |
| CHANGE OF MAILING ADDRESS | 2021-07-08 | 7539-41 WEST OAKLAND PARK BLVD, LAUDERHILL, FL 33319 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-07-08 | 7539-41 WEST OAKLAND PARK BLVD, LAUDERHILL, FL 33319 | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2014-09-26 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-05-01 |
| ANNUAL REPORT | 2023-09-12 |
| AMENDED ANNUAL REPORT | 2022-09-27 |
| ANNUAL REPORT | 2022-02-07 |
| AMENDED ANNUAL REPORT | 2021-08-23 |
| REINSTATEMENT | 2021-07-08 |
| Domestic Profit | 2013-10-14 |
| Off/Dir Resignation | 2013-10-14 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
