| Entity Name: | FORT WALTON BEACH ANESTHESIA, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Florida Limited Liability Co.
FORT WALTON BEACH ANESTHESIA, LLC is structured as a Limited Liability Company (LLC), a common business structure that offers its members limited liability protection, separating their personal assets from the company's debts and obligations. |
| Status: |
Inactive
The business entity is inactive. This status may signal operational issues or voluntary closure, raising concerns about the business's ability to repay loans and requiring careful risk assessment by lenders. |
| Date Filed: | 20 Dec 2002 (22 years ago) |
| Date of dissolution: | 22 Sep 2017 (8 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 22 Sep 2017 (8 years ago) |
| Document Number: | L02000034486 |
| FEI/EIN Number |
061670989
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 8201 UNIVERSITY PKWY, PENSACOLA, FL, 32514 |
| Mail Address: | 8201 UNIVERSITY PKWY, PENSACOLA, FL, 32514 |
| ZIP code: | 32514 |
| County: | Escambia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1538159652 | 2005-10-28 | 2008-06-24 | 8201 UNIVERSITY PKWY, PENSACOLA, FL, 325144904, US | 1000 MAR WALT DR, FORT WALTON BEACH, FL, 325476708, US | |||||||||||||||||||||||||||||||
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| Phone | +1 850-474-8688 |
| Fax | 8509692910 |
Authorized person
| Name | ANDY POPPLE |
| Role | EXECUTIVE DIRECTOR |
| Phone | 8504748000 |
Taxonomy
| Taxonomy Code | 207L00000X - Anesthesiology Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | RAILROAD MEDICARE |
| Number | CK6290 |
| Issuer | BLUE SHIELD |
| Number | 24572 |
| State | FL |
| Issuer | MEDICAID |
| Number | 266456900 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| HUSTON GARY W | Agent | 125 W ROMANA ST, STE 800, PENSACOLA, FL, 32501 |
| MDV LLC | Manager | - |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2017-09-22 | - | - |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2016-04-14 |
| ANNUAL REPORT | 2015-02-23 |
| ANNUAL REPORT | 2014-04-21 |
| ANNUAL REPORT | 2013-04-23 |
| ANNUAL REPORT | 2012-04-23 |
| ANNUAL REPORT | 2011-05-05 |
| ANNUAL REPORT | 2010-04-27 |
| ANNUAL REPORT | 2009-04-23 |
| ANNUAL REPORT | 2008-02-26 |
| ANNUAL REPORT | 2007-04-26 |
Date of last update: 02 Apr 2025
Sources: Florida Department of State
