| Entity Name: | INSIGHT MEDICAL CLINICIANS PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 16 Sep 2024 (5 months ago) |
| Document Number: | P24000059208 |
| Address: | 6303 BLUE LAGOON DR., MIAMI, FL 33126 |
| Mail Address: | 6303 BLUE LAGOON DR., MIAMI, FL 33126 |
| ZIP code: | 33126 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1003633603 | 2024-09-24 | 2024-09-30 | 2510 E SUNSET RD # 5-823, LAS VEGAS, NV, 891203511, US | 6303 BLUE LAGOON DR STE 400, MIAMI, FL, 331266040, US | |||||||||||||||||||||||||||||||
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| Phone | +1 702-685-0877 |
| Fax | 7027495922 |
Authorized person
| Name | FRANCHESCA VAN BUREN |
| Role | CHIEF ADMINISTRATIVE OFFICER |
| Phone | 7026850877 |
Taxonomy
| Taxonomy Code | 103TP0016X - Prescribing (Medical) Psychologist |
| Is Primary | No |
| Taxonomy Code | 207P00000X - Emergency Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 251S00000X - Community/Behavioral Health Agency |
| Is Primary | No |
| Taxonomy Code | 261QM0801X - Mental Health Clinic/Center (Including Community Mental Health Center) |
| Is Primary | Yes |
| Taxonomy Code | 261QM1300X - Multi-Specialty Clinic/Center |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| CHONG, KYLE | Agent | 6303 BLUE LAGOON DR., MIAMI, FL 33126 |
| Name | Role | Address |
|---|---|---|
| CHONG, KYLE | President | 6303 BLUE LAGOON DR., MIAMI, FL 33126 |
| Name | Date |
|---|---|
| Domestic Profit | 2024-09-16 |
Date of last update: 06 Jan 2025
Sources: Florida Department of State
