| Entity Name: | PALM BEACH VASCULAR AND WOUND CARE PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 12 Oct 2016 (8 years ago) |
| Document Number: | P16000083113 |
| FEI/EIN Number | 81-4120239 |
| Mail Address: | 128 DALENA WAY, PALM BEACH GARDENS, FL 33418 |
| Address: | 128 dalena way, palmbeach gardens, FL 33418 |
| ZIP code: | 33418 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1093266314 | 2016-10-21 | 2024-02-15 | 1004 S OLD DIXIE HWY STE 203, JUPITER, FL, 334587200, US | 1004 S OLD DIXIE HWY STE 203, JUPITER, FL, 334587200, US | |||||||||||||||||||||||||
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| Phone | +1 561-691-1904 |
Authorized person
| Name | SURESH B KACHAM |
| Role | MD |
| Phone | 5616911904 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | ME77546 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 207RC0000X - Cardiovascular Disease Physician |
| License Number | ME77546 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| KACHAM, SURESH B | Agent | 128 DALENA WAY, PALM BEACH GARDENS, FL 33418 |
| Name | Role | Address |
|---|---|---|
| KACHAM, SURESH B | Director | 128 DALENA WAY, PALM BEACH GARDENS, FL 33418 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-03-06 | 128 dalena way, palmbeach gardens, FL 33418 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-05 |
| ANNUAL REPORT | 2023-03-06 |
| ANNUAL REPORT | 2022-02-04 |
| ANNUAL REPORT | 2021-01-24 |
| ANNUAL REPORT | 2020-02-26 |
| ANNUAL REPORT | 2019-04-07 |
| ANNUAL REPORT | 2018-03-21 |
| ANNUAL REPORT | 2017-04-21 |
| Domestic Profit | 2016-10-12 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 2569368400 | 2021-02-03 | 0455 | PPS | 128 Dalena Way, Palm Beach Gardens, FL, 33418-1739 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 3513397310 | 2020-04-29 | 0455 | PPP | 128 DALENA WAY, PALM BEACH GARDENS, FL, 33418-1739 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 18 Feb 2025
Sources: Florida Department of State
