| Entity Name: | SPARTAN MEDICAL GROUP, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 08 Feb 2021 (4 years ago) |
| Document Number: | P21000014168 |
| FEI/EIN Number | 86-2110487 |
| Address: | 9145 NARCOOSSEE RD, SUITE 102, ORLANDO, FL 32827 |
| Mail Address: | 10524 MOSS PARK ROAD, SUITE 204-771, ORLANDO, FL 32832 |
| ZIP code: | 32827 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1003577081 | 2022-01-03 | 2022-01-10 | 10524 MOSS PARK RD STE 204-771, ORLANDO, FL, 328325898, US | 9145 NARCOOSSEE RD STE A102, ORLANDO, FL, 328275768, US | |||||||||||||||||
|
|||||||||||||||||||||
| Phone | +1 407-703-6020 |
Authorized person
| Name | KWABENA AMPONSAH |
| Role | CEO/PROVIDER |
| Phone | 9379022068 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| AMPONSAH, KWABENA | Agent | 10524 MOSS PARK ROAD, SUITE 204-771, ORLANDO, FL 32832 |
| Name | Role | Address |
|---|---|---|
| AMPONSAH, KWABENA | Chief Executive Officer | 10524 MOSS PARK ROAD, Suite 204-771 ORLANDO, FL 32832 |
| Name | Role | Address |
|---|---|---|
| Amponsah, Daniel | Chief Marketing Officer | 10524 Moss Park Road, Suite 204-771 Orlando, FL 32832 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G21000064359 | SPARTAN MEDICAL MEN'S HEALTH CLINIC | ACTIVE | 2021-05-10 | 2026-12-31 | No data | 10524 MOSS PARK ROAD, SUITE 204-771, ORLANDO, FL, 32832 |
| G21000023628 | SPARTAN HEALTH MEN'S CLINIC | ACTIVE | 2021-02-17 | 2026-12-31 | No data | 10524 MOSS PARK RD, STE 204-771, ORLANDO, FL, 32832 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2022-09-10 | AMPONSAH, KWABENA | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-09-10 | 10524 MOSS PARK ROAD, SUITE 204-771, ORLANDO, FL 32832 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2021-08-26 | 9145 NARCOOSSEE RD, SUITE 102, ORLANDO, FL 32827 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-22 |
| ANNUAL REPORT | 2023-04-17 |
| ANNUAL REPORT | 2022-09-10 |
| Reg. Agent Change | 2021-11-29 |
| Domestic Profit | 2021-02-08 |
Date of last update: 14 Jan 2025
Sources: Florida Department of State
