| Entity Name: | HEALTHCARE AMERICA MEDICAL GROUP, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 28 Oct 1994 (30 years ago) |
| Document Number: | P94000079440 |
| FEI/EIN Number | 650527738 |
| Address: | 3501 CORTEZ ROAD WEST, BRADENTON, FL, 34210, US |
| Mail Address: | 3501 CORTEZ ROAD WEST, BRADENTON, FL, 34210, US |
| ZIP code: | 34210 |
| County: | Manatee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1487665642 | 2006-08-11 | 2008-08-06 | 3501 CORTEZ RD W, BRADENTON, FL, 342103104, US | 3501 CORTEZ RD W, BRADENTON, FL, 342103104, US | |||||||||||||||||||||||||||||||||||||
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| Phone | +1 941-752-2700 |
| Fax | 9417522730 |
Authorized person
| Name | DR. WERTHER R. MARCIALES |
| Role | PRESIDENT |
| Phone | 9417522700 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 208000000X - Pediatrics Physician |
| Is Primary | No |
| Taxonomy Code | 213E00000X - Podiatrist |
| Is Primary | No |
| Taxonomy Code | 332B00000X - Durable Medical Equipment & Medical Supplies |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 376937200 |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| HEALTHCARE AMERICA MEDICAL GROUP, INC. PROFIT SHARING/401K PLAN AND TRUST | 2009 | 650527738 | 2010-08-04 | HEALTHCARE AMERICA MEDICAL GROUP, INC. | 85 | |||||||||||||||||||||||||||||||
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| Administrator’s EIN | 650527738 |
| Plan administrator’s name | HEALTHCARE AMERICA MEDICAL GROUP, INC. |
| Plan administrator’s address | 3501 CORTEZ ROAD W., BRADENTON, FL, 342103104 |
| Administrator’s telephone number | 9417522700 |
Signature of
| Role | Plan administrator |
| Date | 2010-08-04 |
| Name of individual signing | WERTHER MARCIALES |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| NELSON JEFF M | Agent | 3501 CORTEZ ROAD WEST, BRADENTON, FL, 34210 |
| Name | Role | Address |
|---|---|---|
| NELSON JEFF M | Vice President | 3304 PALMA SOLA BLVD., BRADENTON, FL, 34209 |
| Name | Role | Address |
|---|---|---|
| URRUTIA LUIS M | Secretary | 608 51 ST NW, BRADENTON, FL, 34209 |
| Name | Role | Address |
|---|---|---|
| MARCIALES WERTHER M | President | 1012 CIMARRON CIR, BRADENTON, FL, 34209 |
| Name | Role | Address |
|---|---|---|
| FISHCO ROBERT M | Chairman of the Board | 8007 19TH AVE DR W, BRADENTON, FL, 34209 |
| Name | Role | Address |
|---|---|---|
| NARASIMMAN ARUNA M | Treasurer | 7505 PALMER GLEN CIR, SARASOTA, FL, 34240 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2011-09-23 | No data | No data |
| AMENDMENT | 2004-02-24 | No data | No data |
| REINSTATEMENT | 2000-10-17 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2000-09-22 | No data | No data |
| NAME CHANGE AMENDMENT | 1999-05-05 | HEALTHCARE AMERICA MEDICAL GROUP, INC. | No data |
| AMENDED AND RESTATEDARTICLES | 1995-01-27 | No data | No data |
Date of last update: 01 Jan 2025
Sources: Florida Department of State
