| Entity Name: | CONCIERGE PROMED INC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 09 Nov 2022 (2 years ago) |
| Document Number: | P22000085243 |
| FEI/EIN Number | 92-0978376 |
| Address: | 15300 S Jog Rd Ste 203, Delray Beach, FL, 33446, US |
| Mail Address: | 15300 S Jog Rd Ste 203, Delray Beach, FL, 33446, US |
| ZIP code: | 33446 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1144938937 | 2022-11-10 | 2024-08-28 | 15300 S JOG RD STE 203, DELRAY BEACH, FL, 334462166, US | 15300 S JOG RD STE 203, DELRAY BEACH, FL, 334462166, US | |||||||||||||||||||||||||||||||||||||
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| Phone | +1 561-289-4642 |
| Fax | 5612571154 |
Authorized person
| Name | MISS SHANNON MAE MITCHELL |
| Role | CEO |
| Phone | 5612894642 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 251G00000X - Community Based Hospice Care Agency |
| Is Primary | No |
| Taxonomy Code | 253Z00000X - In Home Supportive Care Agency |
| Is Primary | No |
| Taxonomy Code | 261QC1500X - Community Health Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | NPI |
| Number | 1376037374 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MITCHELL SHANNON M | Agent | 125 S State Rd 7, WELLINGTON, FL, 33414 |
| Name | Role | Address |
|---|---|---|
| MITCHELL SHANNON M | President | 125 S State Road 7, Wellington, FL, 33414 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G24000145534 | UBUNTU INTEGRATIVE HEALTH | ACTIVE | 2024-12-02 | 2029-12-31 | No data | 125 S STATE ROAD 7, SUITE 104-342, WELLINGTON, FL, 33414 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-09-16 | 15300 S Jog Rd Ste 203, Delray Beach, FL 33446 | No data |
| CHANGE OF MAILING ADDRESS | 2024-09-16 | 15300 S Jog Rd Ste 203, Delray Beach, FL 33446 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-05-09 | 125 S State Rd 7, Suite 104-342, WELLINGTON, FL 33414 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-05-09 |
| ANNUAL REPORT | 2023-04-14 |
| Domestic Profit | 2022-11-09 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
