| Entity Name: | UNIVERSITY MEDICAL SERVICE ASSOCIATION, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Non-Profit |
| Status: | Active |
| Date Filed: | 09 Aug 1973 (51 years ago) |
| Document Number: | 727147 |
| FEI/EIN Number | 237313346 |
| Address: | UNIV OF SOUTH FLORIDA HEALTH SCIENCES CENT, 12901 BRUCE B. DOWNS BLVD., MDC BOX 62, TAMPA, FL, 33612, US |
| Mail Address: | UNIV OF SOUTH FLORIDA HEALTH SCIENCES CENT, 12901 BRUCE B. DOWNS BLVD., MDC BOX 62, TAMPA, FL, 33612, US |
| ZIP code: | 33612 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1619629672 | 2022-01-21 | 2022-02-17 | PO BOX 917770, ORLANDO, FL, 328910001, US | 13101 BRUCE B DOWNS BLVD, TAMPA, FL, 336123803, US | |||||||||||||||||||||
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| Phone | +1 813-974-0601 |
| Fax | 8135581340 |
Authorized person
| Name | RICHARD J SOBIERAY |
| Role | CFO USF HEALTH |
| Phone | 8138218038 |
Taxonomy
| Taxonomy Code | 252Y00000X - Early Intervention Provider Agency |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 055000101 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SOLIS GERARD | Agent | UNIV OF SOUTH FLORIDA GENERAL COUNSEL, TAMPA, FL, 336206250 |
| Name | Role | Address |
|---|---|---|
| LOCKWOOD CHARLES MD | Director | UNIVERSITY MEDICAL SERVICE ASSOCIATION, TAMPA, FL, 33612 |
| VAN LOVEREN HARRY MD | Director | UNIVERSITY MEDICAL SERVICE ASSOCIATION, TAMPA, FL, 33612 |
| CORIS ERIC MD | Director | UNIVERSITY MEDICAL SERVICE ASSOCIATION INC, TAMPA, FL, 33612 |
| Name | Role | Address |
|---|---|---|
| VAN LOVEREN HARRY MD | Vice President | UNIVERSITY MEDICAL SERVICE ASSOCIATION, TAMPA, FL, 33612 |
| Name | Role | Address |
|---|---|---|
| CORIS ERIC MD | Secretary | UNIVERSITY MEDICAL SERVICE ASSOCIATION INC, TAMPA, FL, 33612 |
| Name | Role | Address |
|---|---|---|
| CORIS ERIC MD | Treasurer | UNIVERSITY MEDICAL SERVICE ASSOCIATION INC, TAMPA, FL, 33612 |
| Name | Role | Address |
|---|---|---|
| LOCKWOOD CHARLES MD | President | UNIVERSITY MEDICAL SERVICE ASSOCIATION, TAMPA, FL, 33612 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| AMENDMENT | 2019-07-02 | No data | No data |
| AMENDED AND RESTATEDARTICLES | 2017-03-15 | No data | No data |
| AMENDED AND RESTATEDARTICLES | 2014-12-12 | No data | No data |
| AMENDED AND RESTATEDARTICLES | 2009-10-05 | No data | No data |
| AMENDED AND RESTATEDARTICLES | 2003-04-21 | No data | No data |
| AMENDED AND RESTATEDARTICLES | 2000-06-09 | No data | No data |
| AMENDMENT | 1998-08-20 | No data | No data |
| AMENDED AND RESTATEDARTICLES | 1995-01-04 | No data | No data |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
