| Entity Name: | WINTER HAVEN CV ANESTHESIA, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 07 Jul 2005 (20 years ago) |
| Document Number: | L05000067268 |
| FEI/EIN Number | 203115287 |
| Address: | 150 SE 17th St., #503, OCALA, FL, 34471, US |
| Mail Address: | 150 SE 17th St., #503, OCALA, FL, 34471, US |
| ZIP code: | 34471 |
| County: | Marion |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1346283124 | 2006-06-13 | 2020-08-25 | 150 SE 17TH ST STE 503, OCALA, FL, 344715176, US | 200 AVENUE F NE, 2 MAIN ENDO HALL #4, WINTER HAVEN, FL, 338814131, US | |||||||||||||||||||||||||||||||
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| Phone | +1 352-433-2825 |
| Fax | 3524332893 |
| Phone | +1 863-294-8400 |
| Fax | 8632948536 |
Authorized person
| Name | VINCENT C. PALMIRE |
| Role | PARTNER |
| Phone | 3524332825 |
Taxonomy
| Taxonomy Code | 207L00000X - Anesthesiology Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 273683700 |
| State | FL |
| Issuer | BCBS OF FLORIDA |
| Number | 99469 |
| State | FL |
| Name | Role |
|---|---|
| CHESTNUT BUSINESS SERVICES, LLC | Agent |
| Name | Role | Address |
|---|---|---|
| PALMIRE VINCENT C | Managing Member | 150 SE 17th St., OCALA, FL, 34471 |
| Name | Role | Address |
|---|---|---|
| DEPUTAT MIKHAIL M | Manager | 150 SE 17th St., OCALA, FL, 34471 |
| FERNANDEZ A. NICOLAS M | Manager | 150 SE 17th St., OCALA, FL, 34471 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2022-03-09 | Chestnut Business Services LLC | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-03-09 | 401 E Jackson St. Suite 3100, Tampa, FL 33602 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2019-04-06 | 150 SE 17th St., #503, OCALA, FL 34471 | No data |
| CHANGE OF MAILING ADDRESS | 2019-04-06 | 150 SE 17th St., #503, OCALA, FL 34471 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-01 |
| ANNUAL REPORT | 2023-03-10 |
| ANNUAL REPORT | 2022-03-09 |
| ANNUAL REPORT | 2021-04-11 |
| ANNUAL REPORT | 2020-04-08 |
| ANNUAL REPORT | 2019-04-06 |
| ANNUAL REPORT | 2018-03-07 |
| ANNUAL REPORT | 2017-03-07 |
| ANNUAL REPORT | 2016-02-22 |
| ANNUAL REPORT | 2015-03-20 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
