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CENTERWELL SENIOR PRIMARY CARE (FL), INC. - Florida Company Profile

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Company Details

Entity Name: CENTERWELL SENIOR PRIMARY CARE (FL), INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 18 Aug 1992 (33 years ago)
Last Event: NAME CHANGE AMENDMENT
Event Date Filed: 05 Feb 2021 (4 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

Key Officers & Management

Name Role Address
Diamond Susan M Director 500 West Main Street, Louisville, KY, 40202
Buckingham Renee J Director 500 West Main Street, Louisville, KY, 40202
Ruschell Joseph M Director 500 West Main Street, Louisville, KY, 40202
Adkins Matt Vice President 500 West Main Street, Louisville, KY, 40202
Feld Daniel K Asso 500 West Main Street, Louisville, KY, 40202
Edwards Douglas M Seni 500 West Main Street, Louisville, KY, 40202
- Agent -

National Provider Identifier

NPI Number:
1831083187
Certification Date:
2025-06-03

Authorized Person:

Name:
MEGAN GALVAN
Role:
CREDENTIALING MANAGER
Phone:

Taxonomy:

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

Contacts:

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G25000085577 CENTERWELL MEDICAL GROUP ACTIVE 2025-07-09 2030-12-31 - 500 WEST MAIN STREET, LOUISVILLE, KY, 40202
G25000083458 CENTERWELL SENIOR PRIMARY CARE OF SOLDIER CITY ACTIVE 2025-07-02 2030-12-31 - 500 WEST MAIN STREET, LOUISVILLE, KY, 40202
G24000154214 CENTERWELL SENIOR PRIMARY CARE OF AZALEA ACTIVE 2024-12-19 2029-12-31 - 500 WEST MAIN STREET, LOUISVILLE, KY, 40202
G24000137548 CENTERWELL SENIOR PRIMARY CARE OF GATEWAY STATION ACTIVE 2024-11-11 2029-12-31 - 500 WEST MAIN STREET, LOUISVILLE, KY, 40202
G24000054229 CENTERWELL SENIOR PRIMARY CARE OF SOUTHCHASE ACTIVE 2024-04-24 2029-12-31 - 500 WEST MAIN STREET, LOUISVILLE, KY, 40202
G21000150255 CENTERWELL SENIOR PRIMARY CARE OF NORTH CENTRAL ACTIVE 2021-11-09 2026-12-31 - 309 W. BASS ST., KISSIMMEE, FL, 34741
G21000150253 CENTERWELL SENIOR PRIMARY CARE OF ALAFAYA ACTIVE 2021-11-09 2026-12-31 - 815 WOODBURY ROAD SUITE 104, ORLANDO, FL, 32828
G21000139020 CENTERWELL SENIOR PRIMARY CARE OF WEST ORANGE ACTIVE 2021-10-15 2026-12-31 - 500 WEST MAIN STREET, LOUISVILLE, KY, 40202
G21000120151 CENTERWELL WEST ORANGE ACTIVE 2021-09-16 2026-12-31 - 500 WEST MAIN STREET, LOUISVILLE, KY, 40202
G21000028779 CENTERWELL SENIOR PRIMARY CARE OF WEST VINE ACTIVE 2021-03-01 2026-12-31 - 500 WEST MAIN STREET, LOUISVILLE, KY, 40202

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2024-03-12 500 West Main Street, Louisville, KY 40202 -
CHANGE OF MAILING ADDRESS 2024-03-12 500 West Main Street, Louisville, KY 40202 -
REGISTERED AGENT ADDRESS CHANGED 2022-08-03 1200 SOUTH PINE ISLAND ROAD, PLANTATION, FL 33332 -
REGISTERED AGENT NAME CHANGED 2022-08-03 C T CORPORATION SYSTEM -
NAME CHANGE AMENDMENT 2021-02-05 CENTERWELL SENIOR PRIMARY CARE (FL), INC. -
NAME CHANGE AMENDMENT 2020-11-17 CENTERWELL PRIMARY CARE (FL), INC. -
AMENDMENT 2017-01-05 - -
NAME CHANGE AMENDMENT 2016-12-16 FAMILY PHYSICIANS OF WINTER PARK, INC. -
MERGER 2009-12-28 - CORPORATION WAS A MERGER RESULT. TOTAL NUMBER OF QUALIFIED CORPORATION(S) INVOLVED WAS 4. MERGER NUMBER 500000102165

Documents

Name Date
AMENDED ANNUAL REPORT 2024-11-11
AMENDED ANNUAL REPORT 2024-09-17
ANNUAL REPORT 2024-03-12
ANNUAL REPORT 2023-05-01
Reg. Agent Change 2022-08-03
ANNUAL REPORT 2022-04-19
ANNUAL REPORT 2021-04-29
Name Change 2021-02-05
Name Change 2020-11-17
ANNUAL REPORT 2020-01-21

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Date of last update: 02 Jul 2025

Sources: Florida Department of State