| Entity Name: | SUMTER PEDIATRICS PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 26 Aug 2014 (10 years ago) |
| Document Number: | P14000071113 |
| FEI/EIN Number | 47-1683504 |
| Address: | 617 S US HWY 301, SUITE B, SUMTERVILLE, FL 33585 |
| Mail Address: | 265 CITRUS TOWER BLVD, SUITE 102, CLERMONT, FL 34711 |
| ZIP code: | 33585 |
| County: | Sumter |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1265005565 | 2021-07-23 | 2021-07-23 | 617 S US 301 STE B, SUMTERVILLE, FL, 335855355, US | 617 S US 301 STE B, SUMTERVILLE, FL, 335855355, US | |||||||||||||||||||
|
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| Phone | +1 352-569-4980 |
Authorized person
| Name | MOHAMMAD AFZAL |
| Role | OWNER |
| Phone | 3523943929 |
Taxonomy
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 014683501 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| AFZAL, MOHAMMAD, DR | Agent | 265 CITRUS TOWER BLVD, SUITE 102, CLERMONT, FL 34711 |
| Name | Role | Address |
|---|---|---|
| AFZAL, MOHAMMAD, DR | President | 265 CITRUS TOWER BLVD SUITE 102, CLERMONT, FL 34711 |
| Name | Role | Address |
|---|---|---|
| AFZAL, NADIA | Vice President | 265 CITRUS TOWER BLVD, SUITE 102, CLERMONT, FL 34711 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2015-01-11 | AFZAL, MOHAMMAD, DR | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-17 |
| ANNUAL REPORT | 2023-02-05 |
| ANNUAL REPORT | 2022-01-28 |
| 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 |
| ANNUAL REPORT | 2015-01-11 |
Date of last update: 21 Jan 2025
Sources: Florida Department of State
