| Entity Name: | SIDNEY POSSICK, M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 31 Dec 1974 (50 years ago) |
| Document Number: | 466988 |
| FEI/EIN Number | 591567074 |
| Address: | 655 N CLYDE MORRIS BLVD, SUITE B, DAYTONA BCH, FL, 32114 |
| Mail Address: | 655 N CLYDE MORRIS BLVD, SUITE B, DAYTONA BCH, FL, 32114 |
| ZIP code: | 32114 |
| County: | Volusia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1174851158 | 2009-12-02 | 2010-01-26 | 655 N CLYDE MORRIS BLVD, SUITE B, DAYTONA BEACH, FL, 321142321, US | 655 N CLYDE MORRIS BLVD, SUITE B, DAYTONA BEACH, FL, 321142321, US | |||||||||||||||||||||||||
|
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| Phone | +1 386-252-5578 |
| Fax | 3862573660 |
Authorized person
| Name | DR. SIDNEY POSSICK |
| Role | PRESIDENT |
| Phone | 3862525578 |
Taxonomy
| Taxonomy Code | 207N00000X - Dermatology Physician |
| License Number | ME19498 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICARE PTAN |
| Number | CM988A |
| State | FL |
| Name | Role | Address |
|---|---|---|
| KANEY, JONATHAN | Agent | ATLANTIC BANK BLDG., DAYTONA BEACH, FL, 32114 |
| Name | Role | Address |
|---|---|---|
| POSSICK, SIDNEY | President | 655 N. CLYDE MORRIS, DAYTONA BEACH, FL |
| Name | Role | Address |
|---|---|---|
| POSSICK, SIDNEY | Director | 655 N. CLYDE MORRIS, DAYTONA BEACH, FL |
| Name | Role | Address |
|---|---|---|
| Bolerjack Daniel JCPA | Authorized Representative | 42 S Peninsula Dr, Daytona Beach, FL, 32118 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2016-09-23 | No data | No data |
Date of last update: 02 Jan 2025
Sources: Florida Department of State
