| Entity Name: | BRADENTON MEDICAL ENTERPRISES, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 19 Jul 1993 (32 years ago) |
| Document Number: | P93000051741 |
| FEI/EIN Number | 650425823 |
| Address: | 9332 State Road 54, Trinity, FL, 34655, US |
| Mail Address: | 19559 NE 10TH AVE, NORTH MIAMI BEACH, FL, 33179, US |
| ZIP code: | 34655 |
| County: | Pasco |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1538188792 | 2006-07-19 | 2010-05-03 | 19559 NE 10TH AVE, N MIAMI BEACH, FL, 331793501, US | 4802 GRAND BLVD, NEW PORT RICHEY, FL, 346525106, US | |||||||||||||||||||||||||||||||
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| Phone | +1 305-651-3261 |
| Fax | 3056512961 |
| Phone | +1 727-815-8385 |
| Fax | 7278487943 |
Authorized person
| Name | ARTURO FERNANDEZ |
| Role | VICE PRESIDENT |
| Phone | 3056513261 |
Taxonomy
| Taxonomy Code | 332BD1200X - Dialysis Equipment & Supplies (DME) |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 209756701 |
| State | FL |
| Issuer | BC BS FLORIDA |
| Number | R8226 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Jeger Steven | Agent | 19559 NE 10TH AVE, NORTH MIAMI BEACH, FL, 33179 |
| Name | Role | Address |
|---|---|---|
| JACOB ALLAN I | President | 19559 NE 10TH AVE, N. MIAMI BEACH, FL, 33179 |
| Name | Role | Address |
|---|---|---|
| JEGER STEVEN B | Vice President | 19559 NE 10TH AVE, N. MIAMI BEACH, FL, 33179 |
| Name | Role | Address |
|---|---|---|
| JACOB ALLAN I | Director | 19559 NE 10TH AVE, N. MIAMI BEACH, FL, 33179 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G10000026229 | PHYSICIANS DIALYSIS | EXPIRED | 2010-03-22 | 2015-12-31 | No data | 4801 GRAND BOULEVARD, NEW PORT RICHEY, FL, 34652 |
| G10000025597 | PHYSICIANS DIALYSIS | ACTIVE | 2010-03-19 | 2025-12-31 | No data | 19559 NE 10TH AVENUE, NORTH MIAMI BEACH, FL, 33179 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2022-04-13 | No data | No data |
Date of last update: 01 Jan 2025
Sources: Florida Department of State
