| Entity Name: | ADVANCED MEDICAL PROVIDER INC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 08 Nov 2017 (7 years ago) |
| Document Number: | P17000089963 |
| FEI/EIN Number | 82-3337617 |
| Address: | 8551 W. SUNRISE BLVD, PLANTATION, FL, 33322, US |
| Mail Address: | 8551 W. Sunrise Blvd., PLANTATION, FL, 33322, US |
| ZIP code: | 33322 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1588377949 | 2023-01-02 | 2023-01-02 | 11510 SW 2ND ST, PLANTATION, FL, 333252922, US | 1560 SAWGRASS CORPORATE PKWY FL 4, SUNRISE, FL, 333232855, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 954-600-8994 |
Authorized person
| Name | MS. JESSY MADHUKAR |
| Role | PRESIDENT |
| Phone | 9546008994 |
Taxonomy
| Taxonomy Code | 171000000X - Military Health Care Provider |
| Is Primary | Yes |
| Taxonomy Code | 261Q00000X - Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 302F00000X - Exclusive Provider Organization |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1104080092 |
| State | FL |
| Issuer | MEDICAID |
| Number | 1144234857 |
| State | HI |
| Issuer | N/A |
| Number | 123 |
| Issuer | MEDICAID |
| Number | 1225233521 |
| State | FL |
| Issuer | MEDICAID |
| Number | 1285743799 |
| State | FL |
| Issuer | MEDICAID |
| Number | 1093700346 |
| State | FL |
| Issuer | MEDICAID |
| Number | 1811979123 |
| State | FL |
| Issuer | MEDICAID |
| Number | 1447629027 |
| State | FL |
| Issuer | MEDICAID |
| Number | 1073520565 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SHULMAN SCOTT CPA | Agent | 5550 GLADES ROAD, BOCA RATON, FL, 33431 |
| Name | Role | Address |
|---|---|---|
| MADHUKAR JESSY | President | 8551 W. Sunrise Blvd., PLANTATION, FL, 33322 |
| Name | Role | Address |
|---|---|---|
| Madhukar Joel | Manager | 8551 W. Sunrise Blvd., PLANTATION, FL, 33322 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2024-02-22 | 8551 W. SUNRISE BLVD, 209, PLANTATION, FL 33322 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2023-03-21 | 8551 W. SUNRISE BLVD, 209, PLANTATION, FL 33322 | No data |
| REGISTERED AGENT NAME CHANGED | 2022-02-22 | SHULMAN, SCOTT, CPA | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-02-22 | 5550 GLADES ROAD, SUITE 500, BOCA RATON, FL 33431 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-13 |
| AMENDED ANNUAL REPORT | 2024-02-22 |
| ANNUAL REPORT | 2024-02-08 |
| ANNUAL REPORT | 2023-03-21 |
| ANNUAL REPORT | 2022-02-22 |
| ANNUAL REPORT | 2021-04-30 |
| ANNUAL REPORT | 2020-06-08 |
| ANNUAL REPORT | 2019-02-07 |
| ANNUAL REPORT | 2018-08-26 |
| Domestic Profit | 2017-11-08 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
