| Entity Name: | MEDICAL SUPERIOR GROUP INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Inactive |
| Date Filed: | 02 Feb 2015 (10 years ago) |
| Date of dissolution: | 22 Sep 2017 (7 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 22 Sep 2017 (7 years ago) |
| Document Number: | P15000010680 |
| FEI/EIN Number | APPLIED FOR |
| Address: | 434 SW 12 AVE, STE 102, MIAMI, FL 33130 |
| Mail Address: | 434 SW 12 AVE, STE 102, MIAMI, FL 33130 |
| ZIP code: | 33130 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1093197329 | 2015-06-23 | 2015-06-23 | 434 SW 12TH AVE, STE 102, MIAMI, FL, 331302440, US | 434 SW 12TH AVE, STE 102, MIAMI, FL, 331302440, US | |||||||||||||||||||||||
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| Phone | +1 305-563-7914 |
Authorized person
| Name | MR. RAFAEL S GRILLO |
| Role | PRESIDENT |
| Phone | 3055637914 |
Taxonomy
| Taxonomy Code | 302R00000X - Health Maintenance Organization |
| License Number | ME66588 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 375697100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SANTIAGO GRILLO, RAFAEL, MD | Agent | 434 SW 12 AVE, STE 102, MIAMI, FL 33130 |
| Name | Role | Address |
|---|---|---|
| SANTIAGO GRILLO, RAFAEL, MD | President | 434 SW 12 AVE STE 102, MIAMI, FL 33130 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2017-09-22 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2016-04-28 |
| Domestic Profit | 2015-02-02 |
Date of last update: 21 Jan 2025
Sources: Florida Department of State
