| Entity Name: | PROVITA PHYSICIAN GROUP CORP |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Domestic Profit
PROVITA PHYSICIAN GROUP CORP is structured as a Domestic Profit Corporation, which, in Florida signifies a Profit Corporation (also known as a C-Corporation). This business structure is recognized as a separate legal entity from its owners. This offers shareholders the benefit of limited liability protection, safeguarding their personal assets from the corporation's debts and obligations, and facilitates raising capital through the issuance of stock. In Florida, Domestic Profit Corporations are governed by Title XXXVI, Chapter 607, Florida Statutes – Florida Business Corporation Act. |
| Status: |
Active
The business entity is active. This status indicates that the business is currently operating and compliant with state regulations, suggesting a lower risk profile for lenders and potentially better creditworthiness. |
| Date Filed: | 17 Mar 2022 (3 years ago) |
| Document Number: | P22000020388 |
| FEI/EIN Number |
88-1297728
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 3157 N University Dr., Davie, FL, 33024, US |
| Mail Address: | 16325 NW 11TH ST, PEMBROKE PINES, FL, 33028, US |
| ZIP code: | 33024 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1992435622 | 2022-06-15 | 2023-03-07 | 3157 N UNIVERSITY DR STE 103, HOLLYWOOD, FL, 330242258, US | 3157 N UNIVERSITY DR STE 103, HOLLYWOOD, FL, 330242258, US | |||||||||||||||||||||||||||
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| Phone | +1 954-322-8985 |
| Fax | 9543228981 |
Authorized person
| Name | ILEANA DELGADO |
| Role | OFFICE MANAGER |
| Phone | 3058789072 |
Taxonomy
| Taxonomy Code | 261Q00000X - Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | CAQH |
| Number | 15388808 |
| State | FL |
| Issuer | MEDICAL LICENSE |
| Number | APRN9243523 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| PLACENCIA OSMANI | President | 16325 NW 11TH ST, PEMBROKE PINES, FL, 33028 |
| PLACENCIA OSMANI | Agent | 16325 NW 11TH ST, PEMBROKE PINES, FL, 33028 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-04-03 | 3157 N University Dr., Suite 103, Davie, FL 33024 | - |
| CHANGE OF MAILING ADDRESS | 2024-04-03 | 3157 N University Dr., Suite 103, Davie, FL 33024 | - |
| REGISTERED AGENT ADDRESS CHANGED | 2024-04-03 | 16325 NW 11TH ST, PEMBROKE PINES, FL 33028 | - |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-03 |
| ANNUAL REPORT | 2023-02-21 |
| Domestic Profit | 2022-03-17 |
Date of last update: 03 Apr 2025
Sources: Florida Department of State
