Entity Name: | BLUE MEDICAL INC. |
Jurisdiction: | FLORIDA |
Filing Type: | Florida Profit Corporation |
Status: | Active |
Date Filed: | 19 Oct 2023 (a year ago) |
Document Number: | P23000074596 |
FEI/EIN Number | 93-4064636 |
Address: | 4651 GREEN PALM LANE, KISSIMMEE, FL 34746 |
Mail Address: | 4651 GREEN PALM LANE, KISSIMMEE, FL 34746 |
ZIP code: | 34746 |
County: | Osceola |
Place of Formation: | FLORIDA |
NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1104666197 | 2024-05-28 | 2024-05-28 | 4651 GREEN PALM LN, KISSIMMEE, FL, 347465991, US | 4651 GREEN PALM LN, KISSIMMEE, FL, 347465991, US | |||||||||||||
|
Phone | +1 201-993-1475 |
Authorized person
Name | DR. ERICKSON ANGEN BALDERA GARCES |
Role | PRIMARY CARE PHYSICIAN |
Phone | 2019931475 |
Taxonomy
Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
Is Primary | Yes |
Name | Role | Address |
---|---|---|
BALDERA, ERICKSON A | Agent | 4651 GREEN PALM LANE, KISSIMMEE, FL 34741 |
Name | Role | Address |
---|---|---|
BALDERA, ERICKSON A | President | 4651 GREEN PALM LANE, KISSIMMEE, FL 34741 |
Event Type | Filed Date | Value | Description |
---|---|---|---|
CHANGE OF PRINCIPAL ADDRESS | 2024-03-22 | 4651 GREEN PALM LANE, KISSIMMEE, FL 34746 | No data |
CHANGE OF MAILING ADDRESS | 2024-03-22 | 4651 GREEN PALM LANE, KISSIMMEE, FL 34746 | No data |
REGISTERED AGENT ADDRESS CHANGED | 2024-03-22 | 4651 GREEN PALM LANE, KISSIMMEE, FL 34741 | No data |
Name | Date |
---|---|
ANNUAL REPORT | 2024-03-22 |
Domestic Profit | 2023-10-19 |
Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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9955817310 | 2020-05-03 | 0455 | PPP | 3307 CANTRELL ST, HOLIDAY, FL, 34690-1820 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 09 Feb 2025
Sources: Florida Department of State