| Entity Name: | PWS MEDICAL, PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 30 Oct 2014 (10 years ago) |
| Date of dissolution: | 10 Apr 2018 (7 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 10 Apr 2018 (7 years ago) |
| Document Number: | P14000089131 |
| FEI/EIN Number | 47-2207544 |
| Address: | 8831 SW 124 Street, MIAMI, FL, 33176, US |
| Mail Address: | PO Box 56-0275, MIAMI, FL, 33156, US |
| ZIP code: | 33176 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1518355718 | 2014-12-23 | 2015-08-04 | PO BOX 560275, MIAMI, FL, 332560275, US | 8200 SW 117TH AVE, #300, MIAMI, FL, 331833856, US | |||||||||||||||||||||||||
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| Phone | +1 305-901-2133 |
| Fax | 3059012117 |
Authorized person
| Name | GUILLERMO SAMPER |
| Role | MEDICAL DOCTOR |
| Phone | 3059012133 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | ME97045 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 00419000 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| RUIZ-HOFSETH LIANA | Agent | 8831 SW 124 Street, MIAMI, FL, 33176 |
| Name | Role | Address |
|---|---|---|
| RUIZ-HOFSETH LIANA | President | PO BOX 56-0275, MIAMI, FL, 33256 |
| Name | Role | Address |
|---|---|---|
| RUIZ-HOFSETH LIANA | Secretary | PO BOX 56-0275, MIAMI, FL, 33256 |
| Name | Role | Address |
|---|---|---|
| SAMPER GUILLERMO | Vice President | PO BOx 56-0275, MIAMI, FL, 33256 |
| Name | Role | Address |
|---|---|---|
| SAMPER GUILLERMO | Treasurer | po Box 56-0275, MIAMI, FL, 33256 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2018-04-10 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2017-04-06 | 8831 SW 124 Street, MIAMI, FL 33176 | No data |
| CHANGE OF MAILING ADDRESS | 2017-04-06 | 8831 SW 124 Street, MIAMI, FL 33176 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2017-04-06 | 8831 SW 124 Street, MIAMI, FL 33176 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2017-04-06 |
| ANNUAL REPORT | 2016-03-07 |
| ANNUAL REPORT | 2015-02-27 |
| Domestic Profit | 2014-10-30 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
