| Entity Name: | ST. PETER MEDICAL GROUP INC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 05 Jun 2018 (7 years ago) |
| Document Number: | P18000050888 |
| FEI/EIN Number | 830852980 |
| Address: | 339 CYPRESS PARKWAY, KISSIMMEE, FL, 34759, US |
| Mail Address: | PO BOX 582170, KISSIMMEE, FL, 34758, US |
| ZIP code: | 34759 |
| County: | Polk |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1942795869 | 2018-06-23 | 2024-09-16 | PO BOX 582170, KISSIMMEE, FL, 347580027, US | 339 CYPRESS PKWY STE 110, KISSIMMEE, FL, 34759, US | |||||||||||||||||||||
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| Phone | +1 407-922-0240 |
| Fax | 4073435199 |
Authorized person
| Name | MIRIAM L RIVERA-IRIZARRY |
| Role | CEO |
| Phone | 4077298173 |
Taxonomy
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1356304828 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| RIVERA-IRIZARRY MIRIAM L | Agent | 339 CYPRESS PARKWAY, POINCIANA, FL, 34759 |
| Name | Role | Address |
|---|---|---|
| RIVERA-IRIZARRY MIRIAM L | President | PO BOX 582170, KISSIMMEE, FL, 34758 |
| Name | Role | Address |
|---|---|---|
| JORGE-RIVERA JAIME | Vice President | PO BOX 582170, KISSIMMEE, FL, 34758 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-01-27 | 339 CYPRESS PARKWAY, SUITE 110, KISSIMMEE, FL 34759 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-01-27 | 339 CYPRESS PARKWAY, SUITE 110, POINCIANA, FL 34759 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-18 |
| ANNUAL REPORT | 2023-01-27 |
| ANNUAL REPORT | 2022-04-25 |
| ANNUAL REPORT | 2021-04-19 |
| ANNUAL REPORT | 2020-05-19 |
| ANNUAL REPORT | 2019-04-30 |
| Domestic Profit | 2018-06-05 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
