| Entity Name: | HOPE MEDICAL PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 22 Jan 2019 (6 years ago) |
| Document Number: | P19000007625 |
| FEI/EIN Number | 83-3324221 |
| Address: | 11419 W PALMETTO PARK RD UNIT 970811, BOCA RATON, FL, 33497, US |
| Mail Address: | 11419 W. Palmetto Park Rd Ste 970811, Boca Raton, FL, 33497, US |
| ZIP code: | 33497 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1942823711 | 2020-05-27 | 2020-05-27 | 11419 W PALMETTO PARK RD UNIT 97081, BOCA RATON, FL, 334972501, US | 11419 W PALMETTO PARK RD, UNIT 97081, BOCA RATON, FL, 334972501, US | |||||||||||||||||||||
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| Phone | +1 561-843-8460 |
| Fax | 5619223211 |
Authorized person
| Name | WAYNE S BLAKE |
| Role | DO/OWNER |
| Phone | 5618438460 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAL LICENSE |
| Number | OS10255 |
| State | FL |
| Name | Role |
|---|---|
| REPUBLIC REGISTERED AGENT LLC | Agent |
| Name | Role | Address |
|---|---|---|
| BLAKE WAYNE | Director | 11419 W PALMETTO PARK RD UNIT 970811, BOCA RATON, FL, 33497 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2024-04-29 | 11419 W PALMETTO PARK RD UNIT 970811, BOCA RATON, FL 33497 | No data |
| REGISTERED AGENT NAME CHANGED | 2024-04-29 | REPUBLIC REGISTERED AGENT LLC | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-04-29 | 1150 NW 72ND AVE TOWER 1, STE 455, MIAMI, FL 33126 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2021-04-29 | 11419 W PALMETTO PARK RD UNIT 970811, BOCA RATON, FL 33497 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-29 |
| ANNUAL REPORT | 2023-04-13 |
| ANNUAL REPORT | 2022-04-30 |
| ANNUAL REPORT | 2021-04-29 |
| ANNUAL REPORT | 2020-06-03 |
| Domestic Profit | 2019-01-22 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
