| Entity Name: | FLORIDA PHYSICIANS GROUP INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 31 Jul 1995 (30 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 26 Sep 2014 (10 years ago) |
| Document Number: | P95000058912 |
| FEI/EIN Number | 65-0598038 |
| Address: | 686 EAST 49TH STREET, HIALEAH, FL 33013 |
| Mail Address: | 521 RAVEN AVE, MIAMI SPRINGS, FL 33166 |
| ZIP code: | 33013 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1912189192 | 2007-11-29 | 2020-07-30 | 521 RAVEN AVE, MIAMI SPRINGS, FL, 331663950, US | 686 E 49TH ST, HIALEAH, FL, 330131964, US | |||||||||||||||||||||||||||||||
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| Phone | +1 305-696-7921 |
| Fax | 3056889671 |
Authorized person
| Name | DR. WILFRIDO BENITEZ |
| Role | OWNER |
| Phone | 3056967921 |
Taxonomy
| Taxonomy Code | 208D00000X - General Practice Physician |
| License Number | ME68516 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS |
| Number | 40272A |
| State | FL |
| Issuer | MEDICAID |
| Number | 379024001 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BENITEZ, WILFRIDO A | Agent | 686 E 49 STREET, HIALEAH, FL 33013 |
| Name | Role | Address |
|---|---|---|
| BENITEZ, WILFRIDO A | President | 686 E 49 STREET, HIALEAH, FL 33013 |
| Name | Role | Address |
|---|---|---|
| FINALE, NOELyS | Vice President | 686 E 49 STREET, HIALEAH, FL 33013 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| AMENDMENT | 2014-09-26 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2014-09-26 | 686 EAST 49TH STREET, HIALEAH, FL 33013 | No data |
| CHANGE OF MAILING ADDRESS | 2014-09-26 | 686 EAST 49TH STREET, HIALEAH, FL 33013 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2014-09-26 | 686 E 49 STREET, HIALEAH, FL 33013 | No data |
| CANCEL ADM DISS/REV | 2007-10-26 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2007-09-14 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-05 |
| ANNUAL REPORT | 2023-01-25 |
| ANNUAL REPORT | 2022-01-25 |
| ANNUAL REPORT | 2021-02-02 |
| ANNUAL REPORT | 2020-01-30 |
| ANNUAL REPORT | 2019-01-18 |
| ANNUAL REPORT | 2018-01-16 |
| ANNUAL REPORT | 2017-01-10 |
| ANNUAL REPORT | 2016-01-07 |
| ANNUAL REPORT | 2015-01-12 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
