| Entity Name: | JAX ANESTHESIA PROVIDERS, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 27 Feb 2003 (22 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 29 Sep 2005 (19 years ago) |
| Document Number: | L03000007295 |
| FEI/EIN Number | 020687052 |
| Address: | 4800 BELFORT ROAD, JACKSONVILLE, FL, 32256 |
| Mail Address: | 4800 BELFORT ROAD, JACKSONVILLE, FL, 32256 |
| ZIP code: | 32256 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1245271154 | 2006-06-10 | 2010-01-12 | 4800 BELFORT RD, JACKSONVILLE, FL, 322566004, US | 4800 BELFORT RD, JACKSONVILLE, FL, 322566004, US | |||||||||||||||||||||||
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| Phone | +1 904-483-5850 |
| Fax | 9044835960 |
| Fax | 9044835860 |
Authorized person
| Name | DR. JACK R GROOVER |
| Role | CEO |
| Phone | 9044835850 |
Taxonomy
| Taxonomy Code | 207L00000X - Anesthesiology Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 277552200 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| GOL JOHN CFO | Agent | 4800 BELFORT ROAD, JACKSONVILLE, FL, 32256 |
| Name | Role | Address |
|---|---|---|
| ETZKORN KYLE | President | 4800 BELFORT ROAD, JACKSONVILLE, FL, 32256 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2019-04-19 | GOL, JOHN, CFO | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2016-09-30 | 4800 BELFORT ROAD, JACKSONVILLE, FL 32256 | No data |
| REINSTATEMENT | 2005-09-29 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2005-09-16 | No data | No data |
| AMENDED AND RESTATEDARTICLES | 2003-05-08 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2003-03-21 | 4800 BELFORT ROAD, JACKSONVILLE, FL 32256 | No data |
| AMENDMENT | 2003-03-21 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2003-03-21 | 4800 BELFORT ROAD, JACKSONVILLE, FL 32256 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-26 |
| ANNUAL REPORT | 2023-03-06 |
| ANNUAL REPORT | 2022-03-03 |
| ANNUAL REPORT | 2021-02-03 |
| ANNUAL REPORT | 2020-03-18 |
| ANNUAL REPORT | 2019-04-19 |
| ANNUAL REPORT | 2018-01-15 |
| ANNUAL REPORT | 2017-02-14 |
| AMENDED ANNUAL REPORT | 2016-09-30 |
| ANNUAL REPORT | 2016-01-26 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
