| Entity Name: | WESTON MEDICAL CLINIC, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 13 Apr 1999 (26 years ago) |
| Document Number: | P99000033438 |
| FEI/EIN Number | 650938092 |
| Address: | 17120 ROYAL PALM BLVD, STE 4, WESTON, FL, 33326, US |
| Mail Address: | 17120 ROYAL PALM BLVD, STE 4, WESTON, FL, 33326, US |
| ZIP code: | 33326 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1609894484 | 2006-07-18 | 2010-08-30 | 17120 ROYAL PALM BLVD, SUITE 4, WESTON, FL, 333262310, US | 17120 ROYAL PALM BLVD, SUITE 4, WESTON, FL, 333262310, US | |||||||||||||||||||||||||
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| Phone | +1 954-385-3711 |
| Fax | 9543859366 |
Authorized person
| Name | PHANOR CALLE |
| Role | PRESIDENT |
| Phone | 9543859711 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | ME0073727 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 255505100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CALLE PHANOR | Agent | 17120 ROYAL PALM BLVD, WESTON, FL, 33326 |
| Name | Role | Address |
|---|---|---|
| CALLE PHANOR | President | 17120 ROYAL PALM BLVD SUITE 4, WESTON, FL, 33326 |
| Name | Role | Address |
|---|---|---|
| CALLE PHANOR | Vice President | 17120 ROYAL PALM BLVD SUITE 4, WESTON, FL, 33326 |
| Name | Role | Address |
|---|---|---|
| CALLE PHANOR | Secretary | 17120 ROYAL PALM BLVD SUITE 4, WESTON, FL, 33326 |
| Name | Role | Address |
|---|---|---|
| CALLE PHANOR | Treasurer | 17120 ROYAL PALM BLVD SUITE 4, WESTON, FL, 33326 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2006-04-12 | 17120 ROYAL PALM BLVD, STE 4, WESTON, FL 33326 | No data |
| CHANGE OF MAILING ADDRESS | 2006-04-12 | 17120 ROYAL PALM BLVD, STE 4, WESTON, FL 33326 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2006-04-12 | 17120 ROYAL PALM BLVD, SUITE 4, WESTON, FL 33326 | No data |
| REGISTERED AGENT NAME CHANGED | 2003-04-25 | CALLE, PHANOR | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-05 |
| ANNUAL REPORT | 2023-04-19 |
| ANNUAL REPORT | 2022-04-06 |
| ANNUAL REPORT | 2021-04-09 |
| ANNUAL REPORT | 2020-06-08 |
| ANNUAL REPORT | 2019-04-19 |
| ANNUAL REPORT | 2018-04-30 |
| ANNUAL REPORT | 2017-04-05 |
| ANNUAL REPORT | 2016-04-25 |
| ANNUAL REPORT | 2015-04-15 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
