| Entity Name: | MEDATLANTIC PHYSICIANS, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 17 Dec 2013 (11 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 04 Jun 2020 (5 years ago) |
| Document Number: | P13000099985 |
| FEI/EIN Number | 46-4340619 |
| Address: | 325 S DIXIE HIGHWAY, Suite 1, Lake Worth Beach, FL 33460 |
| Mail Address: | 325 S DIXIE HIGHWAY, Suite 1, Lake Worth Beach,, FL 33460 |
| ZIP code: | 33460 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1740684257 | 2014-10-13 | 2014-10-13 | 400 SOUTH DIXIE HIGHWAY, SUITE 12, LAKE WORTH, FL, 33460, US | 400 SOUTH DIXIE HIGHWAY, SUITE 12, LAKE WORTH, FL, 33460, US | |||||||||||||||||||||
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| Phone | +1 561-568-1272 |
| Fax | 5613453521 |
Authorized person
| Name | DR. ADRIENE MILLER |
| Role | PRESIDENT |
| Phone | 5615681272 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 008044209 |
| State | FL |
| Name | Role |
|---|---|
| MEDATLANTIC PHYSICIANS, P.A. | Agent |
| Name | Role | Address |
|---|---|---|
| MILLER, ADRIENE | Director | 4832 ESEDRA COURT #106, 106 LAKE WORTH, FL 33467 |
| Name | Role | Address |
|---|---|---|
| MILLER, ADRIENE | President | 4832 ESEDRA COURT #106, 106 LAKE WORTH, FL 33467 |
| Name | Role | Address |
|---|---|---|
| MILLER, ADRIENE | Secretary | 4832 ESEDRA COURT #106, 106 LAKE WORTH, FL 33467 |
| Name | Role | Address |
|---|---|---|
| MILLER, ADRIENE | Treasurer | 4832 ESEDRA COURT #106, 106 LAKE WORTH, FL 33467 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2021-01-30 | 325 S DIXIE HIGHWAY, Suite 1, Lake Worth Beach, FL 33460 | No data |
| CHANGE OF MAILING ADDRESS | 2021-01-30 | 325 S DIXIE HIGHWAY, Suite 1, Lake Worth Beach, FL 33460 | No data |
| REINSTATEMENT | 2020-06-04 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2020-06-04 | MedAtlantic Physicians, P.A. | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2019-09-27 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2015-08-05 | 4832 ESEDRA COURT #106, LAKE WORTH, FL 33467 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-14 |
| ANNUAL REPORT | 2023-04-04 |
| ANNUAL REPORT | 2022-02-15 |
| ANNUAL REPORT | 2021-01-30 |
| REINSTATEMENT | 2020-06-04 |
| ANNUAL REPORT | 2018-04-01 |
| ANNUAL REPORT | 2017-04-01 |
| ANNUAL REPORT | 2016-03-26 |
| ANNUAL REPORT | 2015-08-05 |
| Domestic Profit | 2013-12-17 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 3643607408 | 2020-05-07 | 0455 | PPP | 325 S DIXIE HWY STE 1, LAKE WORTH, FL, 33460-4423 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 21 Feb 2025
Sources: Florida Department of State
