| Entity Name: | SUPRA MEDICAL GROUP, INC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 29 Oct 2013 (11 years ago) |
| Date of dissolution: | 22 Sep 2023 (a year ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 22 Sep 2023 (a year ago) |
| Document Number: | P13000088692 |
| FEI/EIN Number | 46-4044217 |
| Address: | 3157 N UNIVERSITY DRIVE, DAVIE, FL, 33024, US |
| Mail Address: | 3157 N UNIVERSITY DR, DAVIE, FL, 33024, US |
| ZIP code: | 33024 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1285056663 | 2014-01-20 | 2022-07-21 | 201 NW 70TH AVE STE A, PLANTATION, FL, 333172369, US | 201 NW 70TH AVE STE A, PLANTATION, FL, 333172369, US | |||||||||||||||||||||||
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| Phone | +1 305-485-1532 |
| Fax | 3054851534 |
Authorized person
| Name | RAFAEL SOSA |
| Role | OWNER |
| Phone | 3054851532 |
Taxonomy
| Taxonomy Code | 261Q00000X - Clinic/Center |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | AHCA |
| Number | HCC10035 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Sosa Rafael | Agent | 3157 N UNIVERSITY DRIVE, DAVIE, FL, 33024 |
| Name | Role | Address |
|---|---|---|
| PETERSEN KYLE H | Director | 3157 N UNIVERSITY DR, DAVIE, FL, 33024 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2023-09-22 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-04-29 | 3157 N UNIVERSITY DRIVE, SUITE 102, DAVIE, FL 33024 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2022-04-29 | 3157 N UNIVERSITY DRIVE, SUITE 102, DAVIE, FL 33024 | No data |
| CHANGE OF MAILING ADDRESS | 2022-04-29 | 3157 N UNIVERSITY DRIVE, SUITE 102, DAVIE, FL 33024 | No data |
| REGISTERED AGENT NAME CHANGED | 2019-10-17 | Sosa, Rafael | No data |
| REINSTATEMENT | 2019-10-17 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2019-09-27 | No data | No data |
| AMENDMENT | 2016-12-05 | No data | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J18000402974 | LAPSED | 2017-018501-SP-23 | MIAMI-DADE COUNTY | 2018-05-01 | 2023-06-13 | $4,450.18 | HENRY SCHEIN, INC., 135 DURYEA RD., MELVILLE, NY 11747 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2022-04-29 |
| ANNUAL REPORT | 2021-04-12 |
| ANNUAL REPORT | 2020-06-30 |
| REINSTATEMENT | 2019-10-17 |
| ANNUAL REPORT | 2018-01-24 |
| ANNUAL REPORT | 2017-01-09 |
| Amendment | 2016-12-05 |
| ANNUAL REPORT | 2016-03-18 |
| ANNUAL REPORT | 2015-03-31 |
| ANNUAL REPORT | 2014-06-10 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
