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CENTERWELL SENIOR PRIMARY CARE (FL), INC.

Company Details

Entity Name: CENTERWELL SENIOR PRIMARY CARE (FL), INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 18 Aug 1992 (32 years ago)
Document Number: V58206
FEI/EIN Number 59-3164234
Address: 500 West Main Street, Louisville, KY, 40202, US
Mail Address: 500 West Main Street, Louisville, KY, 40202, US
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1487481875 2024-09-18 2024-09-18 6101 BLUE LAGOON DR STE 200, MIAMI, FL, 331263168, US 1471B E OSCEOLA PKWY, KISSIMMEE, FL, 347441604, US

Contacts

Phone +1 305-500-2000

Authorized person

Name ANGIE MARTINEZ
Role SENIOR CREDENTIALING PROFESSIONAL
Phone 4074477120

Taxonomy

Taxonomy Code 207Q00000X - Family Medicine Physician
Is Primary No
Taxonomy Code 207R00000X - Internal Medicine Physician
Is Primary Yes
Taxonomy Code 208D00000X - General Practice Physician
Is Primary No

Agent

Name Role
C T CORPORATION SYSTEM Agent

Director

Name Role Address
Broussard Bruce D Director 500 West Main Street, Louisville, KY, 40202
Buckingham Renee J Director 500 West Main Street, Louisville, KY, 40202
Fleming William Kevin Director 500 West Main Street, Louisville, KY, 40202

President

Name Role Address
Buckingham Renee J President 500 West Main Street, Louisville, KY, 40202

Vice President

Name Role Address
Judd Patrick Nichol Vice President 500 West Main Street, Louisville, KY, 40202
Ruschell Joseph D Vice President 500 West Main Street, Louisville, KY, 40202

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G24000154214 CENTERWELL SENIOR PRIMARY CARE OF AZALEA ACTIVE 2024-12-19 2029-12-31 No data 500 WEST MAIN STREET, LOUISVILLE, KY, 40202
G24000137548 CENTERWELL SENIOR PRIMARY CARE OF GATEWAY STATION ACTIVE 2024-11-11 2029-12-31 No data 500 WEST MAIN STREET, LOUISVILLE, KY, 40202
G24000054229 CENTERWELL SENIOR PRIMARY CARE OF SOUTHCHASE ACTIVE 2024-04-24 2029-12-31 No data 500 WEST MAIN STREET, LOUISVILLE, KY, 40202
G21000150253 CENTERWELL SENIOR PRIMARY CARE OF ALAFAYA ACTIVE 2021-11-09 2026-12-31 No data 815 WOODBURY ROAD SUITE 104, ORLANDO, FL, 32828
G21000150255 CENTERWELL SENIOR PRIMARY CARE OF NORTH CENTRAL ACTIVE 2021-11-09 2026-12-31 No data 309 W. BASS ST., KISSIMMEE, FL, 34741
G21000139020 CENTERWELL SENIOR PRIMARY CARE OF WEST ORANGE ACTIVE 2021-10-15 2026-12-31 No data 500 WEST MAIN STREET, LOUISVILLE, KY, 40202
G21000120151 CENTERWELL WEST ORANGE ACTIVE 2021-09-16 2026-12-31 No data 500 WEST MAIN STREET, LOUISVILLE, KY, 40202
G21000028781 CENTERWELL SENIOR PRIMARY CARE OF WINTER PARK ACTIVE 2021-03-01 2026-12-31 No data 500 WEST MAIN STREET, LOUISVILLE, KY, 40202
G21000028779 CENTERWELL SENIOR PRIMARY CARE OF WEST VINE ACTIVE 2021-03-01 2026-12-31 No data 500 WEST MAIN STREET, LOUISVILLE, KY, 40202
G21000028774 CENTERWELL SENIOR PRIMARY CARE OF PINE HILLS ACTIVE 2021-03-01 2026-12-31 No data 500 WEST MAIN STREET, LOUISVILLE, KY, 40202

Events

Event Type Filed Date Value Description
NAME CHANGE AMENDMENT 2021-02-05 CENTERWELL SENIOR PRIMARY CARE (FL), INC. No data
NAME CHANGE AMENDMENT 2020-11-17 CENTERWELL PRIMARY CARE (FL), INC. No data
AMENDMENT 2017-01-05 No data No data
NAME CHANGE AMENDMENT 2016-12-16 FAMILY PHYSICIANS OF WINTER PARK, INC. No data
MERGER 2009-12-28 No data CORPORATION WAS A MERGER RESULT. TOTAL NUMBER OF QUALIFIED CORPORATION(S) INVOLVED WAS 4. MERGER NUMBER 500000102165

Date of last update: 02 Jan 2025

Sources: Florida Department of State