| Entity Name: | PINES FOOT & ANKLE SURGICAL GROUP, INC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 27 May 1998 (27 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 29 Jan 2004 (21 years ago) |
| Document Number: | P98000047534 |
| FEI/EIN Number | 65-0846878 |
| Address: | 17901 N.W. 5 STREET, SUITE #106, PEMBROKE PINES, FL 33029 |
| Mail Address: | 17901 N.W. 5 STREET, STE. 106, PEMBROKE PINES, FL 33029 |
| ZIP code: | 33029 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1326180795 | 2007-02-13 | 2010-08-19 | PO BOX 825892, PEMBROKE PINES, FL, 330825892, US | 17901 NW 5TH ST, SUITE # 106, PEMBROKE PINES, FL, 330292810, US | |||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 954-704-2888 |
| Fax | 9547040227 |
Authorized person
| Name | DR. JORGE L VALDES |
| Role | PRESIDENT |
| Phone | 9547042888 |
Taxonomy
| Taxonomy Code | 213E00000X - Podiatrist |
| License Number | PO-2687 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 213EP1101X - Primary Podiatric Medicine Podiatrist |
| License Number | PO-2687 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 213ES0103X - Foot & Ankle Surgery Podiatrist |
| License Number | PO-2687 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 390463600 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| VALDES, JORGE LUIS | Agent | 17901 N.W. 5TH STREET, SUITE 106, PEMBROKE PINES, FL 33029 |
| Name | Role | Address |
|---|---|---|
| VALDES, JORGE LUIS | President | 17901 N.W. 5 STREET, STE. 106, PEMBROKE PINES, FL 33029 |
| Name | Role | Address |
|---|---|---|
| VALDES, JORGE JUAN | Secretary | 17901 N.W. 5 STREET, STE. 106, PEMBROKE PINES, FL 33029 |
| Name | Role | Address |
|---|---|---|
| VALDES, MARIA ELENA | Vice President | 17901 N.W 5 STREET,STE. 106, PEMBROKE PINES, FL 33029 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2012-04-11 | 17901 N.W. 5 STREET, SUITE #106, PEMBROKE PINES, FL 33029 | No data |
| REINSTATEMENT | 2004-01-29 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2001-09-21 | No data | No data |
| REINSTATEMENT | 2000-02-14 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2000-02-14 | 17901 N.W. 5TH STREET, SUITE 106, PEMBROKE PINES, FL 33029 | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 1999-09-24 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-06 |
| ANNUAL REPORT | 2023-02-02 |
| ANNUAL REPORT | 2022-02-03 |
| ANNUAL REPORT | 2021-02-12 |
| ANNUAL REPORT | 2020-03-06 |
| ANNUAL REPORT | 2019-06-14 |
| ANNUAL REPORT | 2018-02-21 |
| ANNUAL REPORT | 2017-01-19 |
| ANNUAL REPORT | 2016-03-02 |
| ANNUAL REPORT | 2015-03-23 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
