| Entity Name: | FT. WALTON BEACH GENERAL SURGERY, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Inactive |
| Date Filed: | 09 Nov 2004 (20 years ago) |
| Date of dissolution: | 08 Dec 2008 (16 years ago) |
| Last Event: | LC VOLUNTARY DISSOLUTION |
| Event Date Filed: | 08 Dec 2008 (16 years ago) |
| Document Number: | L04000081379 |
| FEI/EIN Number | 76-0771164 |
| Address: | ONE PARK PLAZA, NASHVILLE, TN 37203 |
| Mail Address: | PO BOX 750, NASHVILLE, TN 37203 |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1194769950 | 2006-06-15 | 2007-09-11 | 1775 LEWIS TURNER BLVD, #102, FT WALTON BEACH, FL, 325471221, US | 1775 LEWIS TURNER BLVD, #102, FT WALTON BEACH, FL, 325471221, US | |||||||||||||
|
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| Phone | +1 850-864-3232 |
Authorized person
| Name | MICKEY PICKLER |
| Role | VP |
| Phone | 8508643232 |
Taxonomy
| Taxonomy Code | 208600000X - Surgery Physician |
| Is Primary | Yes |
| Name | Role |
|---|---|
| C T CORPORATION SYSTEM | Agent |
| Name | Role | Address |
|---|---|---|
| HANKINS, ROBERT SAMUEL JR. | Manager | ONE PARK PLAZA, NASHVILLE, TN 37203 |
| MOORE, A. BRUCE JR | Manager | ONE PARK PLAZA, NASHVILLE, TN 37203 |
| JOHNSON, R. MILTON | Manager | ONE PARK PLAZA, NASHVILLE, TN 37203 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC VOLUNTARY DISSOLUTION | 2008-12-08 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2005-04-28 | ONE PARK PLAZA, NASHVILLE, TN 37203 | No data |
| CHANGE OF MAILING ADDRESS | 2005-04-28 | ONE PARK PLAZA, NASHVILLE, TN 37203 | No data |
| Name | Date |
|---|---|
| LC Voluntary Dissolution | 2008-12-08 |
| ANNUAL REPORT | 2008-04-16 |
| ANNUAL REPORT | 2007-05-01 |
| ANNUAL REPORT | 2006-04-21 |
| ANNUAL REPORT | 2005-04-28 |
| Florida Limited Liabilites | 2004-11-09 |
Date of last update: 29 Jan 2025
Sources: Florida Department of State
