| Entity Name: | PREMIUM PRIMARY CARE & WALK-IN CLINIC INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 15 Nov 2023 (a year ago) |
| Document Number: | P23000080547 |
| FEI/EIN Number | 93-4507342 |
| Address: | 1801 SE HILLMOOR DRIVE, UNIT A-107, PORT SAINT LUCIE, FL 34952 |
| Mail Address: | 1801 SE HILLMOOR DRIVE, UNIT A-107, PORT SAINT LUCIE, FL 34952 |
| ZIP code: | 34952 |
| County: | St. Lucie |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1700654167 | 2023-12-15 | 2023-12-15 | 1801 SE HILLMOOR DR UNIT A-107P, PORT ST LUCIE, FL, 349527553, US | 1801 SE HILLMOOR DR UNIT A-107P, PORT ST LUCIE, FL, 349527553, US | |||||||||||||||
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| Phone | +1 772-446-0950 |
| Fax | 7724460956 |
Authorized person
| Name | PATRICK A VERGEL DE DIOS |
| Role | APRN |
| Phone | 7724460950 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| VERGEL DE DIOS, PATRICK | Agent | 1801 SE HILLMOOR DRIVE, UNIT A-107, PORT SAINT LUCIE, FL 34952 |
| Name | Role | Address |
|---|---|---|
| VERGEL DE DIOS, PATRICK | President | 1801 SE HILLMOOR DRIVE UNIT A-107, PORT SAINT LUCIE, FL 34952 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-28 |
| ANNUAL REPORT | 2024-01-10 |
| Domestic Profit | 2023-11-15 |
Date of last update: 09 Feb 2025
Sources: Florida Department of State
