| Entity Name: | PHYSICAL MEDICINE CENTER, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 02 Jun 1995 (30 years ago) |
| Last Event: | AMENDED AND RESTATED ARTICLES |
| Event Date Filed: | 12 Jun 2003 (22 years ago) |
| Document Number: | P95000042983 |
| FEI/EIN Number | 59-3322200 |
| Address: | 14522 UNIVERSITY POINT PLACE, TAMPA, FL 33613-5425 |
| Mail Address: | 14522 UNIVERSITY POINT PLACE, TAMPA, FL 33613-5425 |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1902810963 | 2006-07-27 | 2010-08-16 | 14522 UNIVERSITY POINT PL, TAMPA, FL, 336135425, US | 14522 UNIVERSITY POINT PL, TAMPA, FL, 336135425, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 813-978-0020 |
| Fax | 8139729024 |
Authorized person
| Name | DR. ROBERT CARL LUPO |
| Role | OWNER/CLINIC DIRECTOR |
| Phone | 8139780020 |
Taxonomy
| Taxonomy Code | 261QM1300X - Multi-Specialty Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS |
| Number | 22031 |
| State | FL |
| Issuer | LICENSE# |
| Number | PT9405 |
| State | FL |
| Issuer | LICENSE# |
| Number | CH5346 |
| State | FL |
| Issuer | BCBS |
| Number | 21592 |
| State | FL |
| Issuer | LICENSE NUMBER |
| Number | CH9181 |
| State | FL |
| Issuer | LICENSE# |
| Number | ME23061 |
| State | FL |
| Issuer | LICENSE |
| Number | CH8350 |
| State | FL |
| Issuer | BCBS |
| Number | 12043 |
| State | FL |
| Issuer | LICENSE# |
| Number | CH8937 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| LUPO, ROBERT CDR. | Agent | 15804 DAWSON RIDGE, TAMPA, FL 33647 |
| Name | Role | Address |
|---|---|---|
| LUPO, ROBERT CDR. | President | 15804 DAWSON RIDGE DR, TAMPA, FL 33647 |
| Name | Role | Address |
|---|---|---|
| LUPO, CATHERINE M | Secretary | 15804 DAWSON RIDGE DR, TAMPA, FL 33647 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2005-04-28 | 14522 UNIVERSITY POINT PLACE, TAMPA, FL 33613-5425 | No data |
| CHANGE OF MAILING ADDRESS | 2005-04-28 | 14522 UNIVERSITY POINT PLACE, TAMPA, FL 33613-5425 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2005-04-28 | 15804 DAWSON RIDGE, TAMPA, FL 33647 | No data |
| AMENDED AND RESTATEDARTICLES | 2003-06-12 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-06 |
| ANNUAL REPORT | 2023-02-15 |
| ANNUAL REPORT | 2022-03-03 |
| ANNUAL REPORT | 2021-01-27 |
| ANNUAL REPORT | 2020-03-26 |
| ANNUAL REPORT | 2019-02-07 |
| ANNUAL REPORT | 2018-04-23 |
| ANNUAL REPORT | 2017-04-04 |
| ANNUAL REPORT | 2016-03-07 |
| ANNUAL REPORT | 2015-01-14 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
