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BOSWELL MEDICAL GROUP, P.A. - Florida Company Profile

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Company Details

Entity Name: BOSWELL MEDICAL GROUP, P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 19 Jul 2024 (a year ago)
Document Number: P24000047957
FEI/EIN Number 99-4087008
Address: 333 S. E. 2ND AVENUE, SUITE 2000, MIAMI, FL, 33131, US
Mail Address: 333 S. E. 2ND AVENUE, SUITE 2000, MIAMI, FL, 33131, US
ZIP code: 33131
City: Miami
County: Miami-Dade
Place of Formation: FLORIDA

Links between entities

Type:
Headquarter of
Company Number:
001776809
State:
RHODE ISLAND

Key Officers & Management

Name Role Address
KARMOUTA RYAN President 333 S. E. 2ND AVENUE, SUITE 2000, MIAMI, FL, 33131
KARMOUTA RYAN Agent 333 S. E. 2ND AVENUE, MIAMI, FL, 33131

National Provider Identifier

NPI Number:
1477382620
Certification Date:
2024-11-15

Authorized Person:

Name:
BRYAN WANG
Role:
CHIEF ADMINISTRATIVE OFFICER
Phone:

Taxonomy:

Selected Taxonomy:
261QC1500X - Community Health Clinic/Center
Is Primary:
No
Selected Taxonomy:
261QP2300X - Primary Care Clinic/Center
Is Primary:
No
Selected Taxonomy:
363L00000X - Nurse Practitioner
Is Primary:
No
Selected Taxonomy:
207N00000X - Dermatology Physician
Is Primary:
Yes

Contacts:

Form 5500 Series

Employer Identification Number (EIN):
994087008
Plan Year:
2024
Number Of Participants:
0
Sponsors Telephone Number:

Documents

Name Date
Domestic Profit 2024-07-19

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Date of last update: 03 Aug 2025

Sources: Florida Department of State