| Entity Name: | GOLD STAR PEDIATRICS PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 18 Feb 2022 (3 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 31 Mar 2022 (3 years ago) |
| Document Number: | P22000014473 |
| FEI/EIN Number | 880980301 |
| Mail Address: | 1400 LAKE BREEZE CT, NORTH PORT, FL, 34291, US |
| Address: | 3149 BOBCAT VILLAGE CENTER ROAD, NORTH PORT, FL, 34288, US |
| ZIP code: | 34288 |
| County: | Sarasota |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1669129342 | 2022-03-03 | 2023-01-14 | 1400 LAKE BREEZE CT, NORTH PORT, FL, 342918023, US | 3149 BOBCAT VILLAGE CENTER RD # 14, NORTH PORT, FL, 342888974, US | |||||||||||||||||||||||||||||
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| Phone | +1 732-309-1292 |
Authorized person
| Name | DR. JIGNESH BHOGILAL PATEL |
| Role | PRESIDENT |
| Phone | 9412665629 |
Taxonomy
| Taxonomy Code | 208000000X - Pediatrics Physician |
| Is Primary | No |
| Taxonomy Code | 2080N0001X - Neonatal-Perinatal Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | NPI |
| Number | 1003082280 |
| State | FL |
| Issuer | MEDICAID |
| Number | 281244400 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| PATEL JIGNESH B | Agent | 1400 LAKE BREEZE CT, NORTH PORT, FL, 34291 |
| Name | Role | Address |
|---|---|---|
| PATEL JIGNESH B | President | 1400 LAKE BREEZE CT, NORTH PORT, FL, 34291 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2022-04-15 | 3149 BOBCAT VILLAGE CENTER ROAD, #14, NORTH PORT, FL 34288 | No data |
| AMENDMENT | 2022-03-31 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-27 |
| ANNUAL REPORT | 2023-04-08 |
| Amendment | 2022-03-31 |
| Domestic Profit | 2022-02-18 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
