| Entity Name: | MEADOWLANDS MEDICAL CENTER, PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 15 Sep 2017 (7 years ago) |
| Document Number: | P17000075069 |
| FEI/EIN Number | 592362796 |
| Address: | 179 COLLEGE DR, UNIT 17, ORANGE PARK, FL, 32065, US |
| Mail Address: | 179 COLLEGE DR, UNIT 17, ORANGE PARK, FL, 32065, US |
| ZIP code: | 32065 |
| County: | Clay |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1124050711 | 2006-07-06 | 2017-10-25 | 179 COLLEGE DR, STE 17, ORANGE PARK, FL, 320657705, US | 179 COLLEGE DR, STE 17, ORANGE PARK, FL, 320657705, US | |||||||||||||||||||||||||||||||||||
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| Phone | +1 904-272-7272 |
| Fax | 9042727293 |
| Phone | +1 904-592-7818 |
| Fax | 9046025599 |
Authorized person
| Name | MARC LOUIS ALESSANDRIA |
| Role | OWNER/PRESIDENT |
| Phone | 9045927818 |
Taxonomy
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| License Number | ME70009 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS |
| Number | 72398 |
| State | FL |
| Issuer | MEDICAID |
| Number | 265625600 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| ALESSANDRIA MARC LDR | Agent | 1871 SENTRY OAK CT, FLEMING ISLAND, FL, 32003 |
| Name | Role | Address |
|---|---|---|
| ALESSANDRIA MARC L | Director | 1871 SENTRY OAK CT, FLEMING ISLAND, FL, 32003 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-16 |
| ANNUAL REPORT | 2023-02-03 |
| ANNUAL REPORT | 2022-01-24 |
| ANNUAL REPORT | 2021-01-18 |
| ANNUAL REPORT | 2020-01-03 |
| ANNUAL REPORT | 2019-01-27 |
| ANNUAL REPORT | 2018-01-22 |
| Domestic Profit | 2017-09-15 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
