| Entity Name: | DEVOTED MEDICAL GROUP PROFESSIONAL CORPORATION |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 03 Aug 2020 (5 years ago) |
| Document Number: | P20000060357 |
| FEI/EIN Number | 85-2434574 |
| Address: | 221 CRESCENT STREET, SUITE 202, WALTHAM, MA, 02453, US |
| Mail Address: | 221 CRESCENT STREET, SUITE 202, WALTHAM, MA, 02453 |
| Place of Formation: | FLORIDA |
| Type | Company Name | Company Number | State |
|---|---|---|---|
| Headquarter of | DEVOTED MEDICAL GROUP PROFESSIONAL CORPORATION, MISSISSIPPI | 1445945 | MISSISSIPPI |
| Headquarter of | DEVOTED MEDICAL GROUP PROFESSIONAL CORPORATION, KENTUCKY | 1371371 | KENTUCKY |
| Headquarter of | DEVOTED MEDICAL GROUP PROFESSIONAL CORPORATION, COLORADO | 20221976835 | COLORADO |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1245838168 | 2020-10-13 | 2024-01-05 | PO BOX 211699, EAGAN, MN, 551213699, US | 880 SW 145TH AVE STE 202, PEMBROKE PINES, FL, 330276171, US | |||||||||||||||||
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| Phone | +1 866-849-0692 |
Authorized person
| Name | DR. NEIL WAGLE |
| Role | CMO |
| Phone | 6172566666 |
Taxonomy
| Taxonomy Code | 208D00000X - General Practice Physician |
| Is Primary | No |
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| Is Primary | Yes |
| Name | Role |
|---|---|
| REGISTERED AGENT SOLUTIONS, INC. | Agent |
| Name | Role | Address |
|---|---|---|
| Kocher Robert | Chairman | 221 CRESCENT STREET, WALTHAM, MA, 02453 |
| Name | Role | Address |
|---|---|---|
| DELINSKY JEREMY | Chie | 221 CRESCENT STREET, SUITE 202, WALTHAM, MA, 02453 |
| Wagle Neil | Chie | 221 CRESCENT STREET, WALTHAM, MA, 02453 |
| Name | Role | Address |
|---|---|---|
| JERNIGAN PAUL | Secretary | 221 CRESCENT STREET, SUITE 202, WALTHAM, MA, 02453 |
| Name | Role | Address |
|---|---|---|
| Yale W. Bradley | Chief Financial Officer | 221 CRESCENT STREET, WALTHAM, MA, 02453 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2023-04-27 | 2894 REMINGTON GREEN LANE, SUITE A, TALLAHASSEE, FL 32308 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2022-04-23 | 221 CRESCENT STREET, SUITE 202, WALTHAM, MA 02453 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-10 |
| ANNUAL REPORT | 2023-02-16 |
| ANNUAL REPORT | 2022-04-23 |
| ANNUAL REPORT | 2021-07-27 |
| Domestic Profit | 2020-08-03 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
