| Entity Name: | DERMATOLOGY ASSOCIATES OF BAY COUNTY, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 15 Aug 1978 (46 years ago) |
| Last Event: | NAME CHANGE AMENDMENT |
| Event Date Filed: | 08 Feb 1993 (32 years ago) |
| Document Number: | 582230 |
| FEI/EIN Number | 59-1847285 |
| Address: | 1900 HARRISON AVE, PANAMA CITY, FL 32405 |
| Mail Address: | 1900 HARRISON AVE, PANAMA CITY, FL 32405 |
| ZIP code: | 32405 |
| County: | Bay |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1437444817 | 2011-06-14 | 2011-06-16 | 1900 HARRISON AVE, PANAMA CITY, FL, 324054542, US | 3025 6TH ST, MARIANNA, FL, 324461930, US | |||||||||||||||||||||||||||||
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| Phone | +1 850-769-1668 |
| Fax | 8507852123 |
Authorized person
| Name | DR. ROBERT JOHN SIRAGUSA |
| Role | PRESIDENT |
| Phone | 8507691668 |
Taxonomy
| Taxonomy Code | 207N00000X - Dermatology Physician |
| Is Primary | Yes |
| Taxonomy Code | 207ND0101X - MOHS-Micrographic Surgery Physician |
| Is Primary | No |
Other Provider Identifiers
| Issuer | BCBS OF FL |
| Number | 99500 |
| Issuer | MEDICAID |
| Number | 000164600 |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DERMATOLOGY ASSOCIATES OF BAY COUNTY P.A. DEFINED BENEFIT PLAN | 2010 | 591847285 | 2011-07-04 | DERMATOLOGY ASSOCIATES OF BAY COUNTY P.A. | 25 | |||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Administrator’s EIN | 591847285 |
| Plan administrator’s name | DERMATOLOGY ASSOCIATES OF BAY COUNTY P.A. |
| Plan administrator’s address | 1900 HARRISON AVENUE, PANAMA CITY, FL, 32405 |
| Administrator’s telephone number | 8507859315 |
Number of participants as of the end of the plan year
| Active participants | 0 |
| Retired or separated participants receiving benefits | 0 |
| Other retired or separated participants entitled to future benefits | 0 |
| Deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 0 |
| Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 0 |
Signature of
| Role | Plan administrator |
| Date | 2011-07-04 |
| Name of individual signing | ROBERT SIRAGUSA |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2011-07-04 |
| Name of individual signing | ROBERT SIRAGUSA |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2002-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 8507859315 |
| Plan sponsor’s mailing address | 1900 HARRISON AVENUE, PANAMA CITY, FL, 32405 |
| Plan sponsor’s address | ROBERT SIRAGUSA, 1900 HARRISON AVENUE, PANAMA CITY, FL, 32405 |
Plan administrator’s name and address
| Administrator’s EIN | 591847285 |
| Plan administrator’s name | DERMATOLOGY ASSOCIATES OF BAY COUNTY P.A. |
| Plan administrator’s address | 1900 HARRISON AVENUE, PANAMA CITY, FL, 32405 |
| Administrator’s telephone number | 8507859315 |
Number of participants as of the end of the plan year
| Active participants | 19 |
| Retired or separated participants receiving benefits | 0 |
| Other retired or separated participants entitled to future benefits | 4 |
| Deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 0 |
| Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 0 |
Signature of
| Role | Plan administrator |
| Date | 2010-09-16 |
| Name of individual signing | ROBERT SIRAGUSA |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2010-09-16 |
| Name of individual signing | ROBERT SIRAGUSA |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| SIRAGUSA, ROBERT JP | Agent | 1900 HARRISON AVE., PANAMA CITY, FL 32405 |
| Name | Role | Address |
|---|---|---|
| SIRAGUSA, ROBERT JP | President | 1900 HARRISON AVE, PANAMA CITY, FL 32405 |
| Name | Role | Address |
|---|---|---|
| Kovaleski, Tina SD | Secretary | 3000 W 27th Ct, PANAMA CITY, FL 32405 |
| Name | Role | Address |
|---|---|---|
| KOVALESKI, CHARLES RVD | Director | 1900 HARRISON AVE, PANAMA CITY, FL 32405 |
| Kovaleski, Tina SD | Director | 3000 W 27th Ct, PANAMA CITY, FL 32405 |
| Name | Role | Address |
|---|---|---|
| KOVALESKI, CHARLES RVD | Vice President | 1900 HARRISON AVE, PANAMA CITY, FL 32405 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2016-01-27 | 1900 HARRISON AVE, PANAMA CITY, FL 32405 | No data |
| REGISTERED AGENT NAME CHANGED | 2005-01-20 | SIRAGUSA, ROBERT JP | No data |
| CHANGE OF MAILING ADDRESS | 1996-04-26 | 1900 HARRISON AVE, PANAMA CITY, FL 32405 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 1994-04-27 | 1900 HARRISON AVE., PANAMA CITY, FL 32405 | No data |
| NAME CHANGE AMENDMENT | 1993-02-08 | DERMATOLOGY ASSOCIATES OF BAY COUNTY, P.A. | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-30 |
| ANNUAL REPORT | 2023-01-03 |
| ANNUAL REPORT | 2022-01-04 |
| ANNUAL REPORT | 2021-01-26 |
| ANNUAL REPORT | 2020-01-07 |
| ANNUAL REPORT | 2019-01-10 |
| ANNUAL REPORT | 2018-01-30 |
| ANNUAL REPORT | 2017-01-12 |
| ANNUAL REPORT | 2016-01-27 |
| ANNUAL REPORT | 2015-02-12 |
Date of last update: 05 Feb 2025
Sources: Florida Department of State
