| Entity Name: | JEROME SIEGMEISTER MD PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 04 Jan 2022 (3 years ago) |
| Document Number: | P22000000267 |
| FEI/EIN Number | 87-4227624 |
| Address: | 3850 BIRD ROAD, FLOOR 10, MIAMI, FL 33146 |
| Mail Address: | 3850 BIRD ROAD, FLOOR 10, MIAMI, FL 33146 |
| ZIP code: | 33146 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1083375315 | 2022-01-08 | 2022-01-08 | 7712 ALTAMIRA AVE, CORAL GABLES, FL, 331436244, US | 3850 BIRD RD FL 10, MIAMI, FL, 331461501, US | |||||||||||||||||||||||||||
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| Phone | +1 305-666-7225 |
Authorized person
| Name | DR. JEROME ARON SIEGMEISTER |
| Role | OWNER |
| Phone | 3056667225 |
Taxonomy
| Taxonomy Code | 261QM0801X - Mental Health Clinic/Center (Including Community Mental Health Center) |
| Is Primary | No |
| Taxonomy Code | 261QM0850X - Adult Mental Health Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 261QM0855X - Adolescent and Children Mental Health Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | LICENSE |
| Number | ME142120 |
| State | FL |
| Name | Role |
|---|---|
| RICHARD SIEGMEISTER PA | Agent |
| Name | Role | Address |
|---|---|---|
| SIEGMEISTER, JEROME | President | 3850 BIRD ROAD, FLOOR 10, MIAMI, FL 33146 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-23 |
| ANNUAL REPORT | 2023-01-30 |
| Domestic Profit | 2022-01-04 |
Date of last update: 13 Jan 2025
Sources: Florida Department of State
