| Entity Name: | JACKSONVILLE PLASTIC SURGERY, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 24 Feb 1982 (43 years ago) |
| Document Number: | F68501 |
| FEI/EIN Number | 592178819 |
| Address: | 3599 UNIVERSITY BLVD , SOUTH, SUITE 1600, JACKSONVILLE, FL, 32216 |
| Mail Address: | 3599 UNIVERSITY BLVD , SOUTH, SUITE 1600, JACKSONVILLE, FL, 32216 |
| ZIP code: | 32216 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1588985972 | 2010-06-20 | 2010-09-28 | 3599 UNIVERSITY BLVD S, SUITE 1600, JACKSONVILLE, FL, 322164252, US | 3599 UNIVERSITY BLVD S, SUITE 1600, JACKSONVILLE, FL, 322164252, US | |||||||||||||||||||||||||
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| Phone | +1 904-346-0060 |
| Fax | 9043460065 |
Authorized person
| Name | DR. JOHN J OBI |
| Role | PRESIDENT |
| Phone | 9043460060 |
Taxonomy
| Taxonomy Code | 208200000X - Plastic Surgery Physician |
| License Number | ME027754 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICARE ID NUMBER |
| Number | 55094 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| OBI JOHN JDr. | Agent | 3599 UNIVERSITY BLVD , SOUTH, JACKSONVILLE, FL, 32216 |
| Name | Role | Address |
|---|---|---|
| OBI JOHN JDr. | President | 3599 UNIVERSITY BLVD , SOUTH, JACKSONVILLE, FL, 32216 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| NAME CHANGE AMENDMENT | 2000-01-19 | JACKSONVILLE PLASTIC SURGERY, INC. | No data |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
