| Entity Name: | OKALOOSA-WALTON UROLOGY, PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 12 Feb 1986 (39 years ago) |
| Document Number: | H98999 |
| FEI/EIN Number | 630782463 |
| Address: | % THOMAS D. ZACHOS, 131 REDSTONE AVENUE, SUITE #102, CRESTVIEW, FL, 32536 |
| Mail Address: | % THOMAS D. ZACHOS, 4154 Beach Dr, Niceville, FL, 32578, US |
| ZIP code: | 32536 |
| County: | Okaloosa |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1205804432 | 2006-03-14 | 2008-01-24 | 1112 HOSPITAL RD, UNIT A, FORT WALTON BEACH, FL, 325476655, US | 1112 HOSPITAL RD, UNIT A, FORT WALTON BEACH, FL, 325476655, US | |||||||||||||
|
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| Phone | +1 850-682-6333 |
Authorized person
| Name | HELEN MCCOY |
| Role | BILLING MANAGER |
| Phone | 8506826333 |
Taxonomy
| Taxonomy Code | 208800000X - Urology Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| ZACHOS, THOMAS D., M.D. | Agent | 4154 BEACH DRIVE, NICEVILLE, FL, 32578 |
| Name | Role | Address |
|---|---|---|
| ZACHOS, THOMAS D., M.D. | Director | 4154 BEACH DRIVE, NICEVILLE, FL |
| Name | Role | Address |
|---|---|---|
| ZACHOS, THOMAS D., M.D. | President | 4154 BEACH DRIVE, NICEVILLE, FL |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2019-09-27 | No data | No data |
| NAME CHANGE AMENDMENT | 1997-06-17 | OKALOOSA-WALTON UROLOGY, PA | No data |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
