| Entity Name: | SOUTH LAKE PRIMARY CARE, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 19 Jul 1999 (26 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 29 Apr 2011 (14 years ago) |
| Document Number: | P99000066189 |
| FEI/EIN Number | 593588622 |
| Address: | 1503 Sunrise Plaza Dr, CLERMONT, FL, 34714, US |
| Mail Address: | 2885 Columbus Ave, CLERMONT, FL, 34715, US |
| ZIP code: | 34714 |
| County: | Lake |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1164783528 | 2012-06-01 | 2013-08-30 | 1503 SUNRISE PLAZA DR, CLERMONT, FL, 347146200, US | 219 W MYERS BLVD, SUITE C, MASCOTTE, FL, 347539793, US | |||||||||||||||||||||||
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| Phone | +1 352-243-3800 |
| Fax | 3522433804 |
| Phone | +1 352-557-4840 |
| Fax | 3525574839 |
Authorized person
| Name | RAMON SUEIRO |
| Role | MEDICAL DIRECTOR |
| Phone | 3525574840 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | ME0071348 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| SUEIRO RAMON M | Agent | 2885 Columbus Ave, CLERMONT, FL, 34715 |
| Name | Role | Address |
|---|---|---|
| SUEIRO RAMON | Officer | 2885 Columbus Ave, CLERMONT, FL, 34715 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2020-03-07 | 1503 Sunrise Plaza Dr, CLERMONT, FL 34714 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-03-07 | 2885 Columbus Ave, CLERMONT, FL 34715 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2014-04-09 | 1503 Sunrise Plaza Dr, CLERMONT, FL 34714 | No data |
| REINSTATEMENT | 2011-04-29 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2010-09-24 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-26 |
| ANNUAL REPORT | 2023-04-13 |
| ANNUAL REPORT | 2022-04-13 |
| ANNUAL REPORT | 2021-03-09 |
| ANNUAL REPORT | 2020-03-07 |
| ANNUAL REPORT | 2019-03-26 |
| ANNUAL REPORT | 2018-03-29 |
| ANNUAL REPORT | 2017-03-27 |
| ANNUAL REPORT | 2016-04-18 |
| ANNUAL REPORT | 2015-04-10 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
