| Entity Name: | BAYSHORE PODIATRY CENTER INC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 09 Jun 1981 (44 years ago) |
| Last Event: | AMENDMENT AND NAME CHANGE |
| Event Date Filed: | 22 Jul 2021 (4 years ago) |
| Document Number: | F40041 |
| FEI/EIN Number | 59-2093559 |
| Address: | 508 S. HABANA AVE., 230, TAMPA, FL 33609 |
| Mail Address: | 508 S. HABANA AVE., 230, TAMPA, FL 33609 |
| ZIP code: | 33609 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1982688354 | 2005-11-30 | 2024-10-23 | 508 S HABANA AVE STE 230, TAMPA, FL, 336094161, US | 508 S HABANA AVE STE 230, TAMPA, FL, 336094161, US | |||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 813-877-6636 |
| Fax | 8138776610 |
Authorized person
| Name | DR. JAMES EDWARD REPKO |
| Role | PRESIDENT |
| Phone | 8138776636 |
Taxonomy
| Taxonomy Code | 213E00000X - Podiatrist |
| License Number | P00001221 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 213E00000X - Podiatrist |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 213ES0000X - Sports Medicine Podiatrist |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 261QP1100X - Podiatric Clinic/Center |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 041093400 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Repko, James Edward, Dr. | Agent | 508 S. HABANA AVE., 230, TAMPA, FL 33609 |
| Name | Role | Address |
|---|---|---|
| Repko, James Edward, Dr. | President | 508 S. HABANA AVE., 230 TAMPA, FL 33609 |
| Name | Role | Address |
|---|---|---|
| NIEHAUS, SALEENA | Vice President | 508S HABANA AVENUE SUITE 230, TAMPA, FL 33609 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G20000062785 | BAYSHORE PODIATRY CENTER | ACTIVE | 2020-06-04 | 2025-12-31 | No data | 508 S. HABANA AVE, STE 230, TAMPA, FL, 33609 |
| G17000141082 | HEEL PAIN CENTER OF TAMPA BAY | ACTIVE | 2017-12-25 | 2027-12-31 | No data | 508 S HABANA AVE., STE 230, TAMPA, FL, 33609 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| AMENDMENT AND NAME CHANGE | 2021-07-22 | BAYSHORE PODIATRY CENTER INC | No data |
| REGISTERED AGENT NAME CHANGED | 2021-01-13 | Repko, James Edward, Dr. | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2008-01-25 | 508 S. HABANA AVE., 230, TAMPA, FL 33609 | No data |
| CHANGE OF MAILING ADDRESS | 2008-01-25 | 508 S. HABANA AVE., 230, TAMPA, FL 33609 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2008-01-25 | 508 S. HABANA AVE., 230, TAMPA, FL 33609 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-31 |
| ANNUAL REPORT | 2023-01-31 |
| ANNUAL REPORT | 2022-02-02 |
| Amendment and Name Change | 2021-07-22 |
| ANNUAL REPORT | 2021-01-13 |
| ANNUAL REPORT | 2020-02-17 |
| ANNUAL REPORT | 2019-02-12 |
| ANNUAL REPORT | 2018-01-24 |
| ANNUAL REPORT | 2017-02-14 |
| ANNUAL REPORT | 2016-02-22 |
Date of last update: 05 Feb 2025
Sources: Florida Department of State
