| Entity Name: | BAPTIST PHYSICIAN ENTERPRISE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 27 May 2009 (16 years ago) |
| Date of dissolution: | 27 Sep 2013 (11 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 27 Sep 2013 (11 years ago) |
| Document Number: | L09000051222 |
| FEI/EIN Number | 270288317 |
| Address: | 1717 NORTH E STREET,, STE. 320, PENSACOLA, FL, 32501 |
| Mail Address: | 1717 NORTH E STREET,, STE. 320 - ATTN: MARY MATHEWS, PENSACOLA, FL, 32501 |
| ZIP code: | 32501 |
| County: | Escambia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1477860245 | 2010-09-01 | 2011-05-09 | 1717 N E ST, SUITE 227, PENSACOLA, FL, 325016339, US | 1717 N E ST, SUITE 227, PENSACOLA, FL, 325016339, US | |||||||||||||||||||||||||||||||
|
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| Phone | +1 850-437-8604 |
Authorized person
| Name | KENT SKOLROOD |
| Role | PRESIDENT |
| Phone | 8504692334 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 207RR0500X - Rheumatology Physician |
| Is Primary | No |
| Taxonomy Code | 208000000X - Pediatrics Physician |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 002797300 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CALLAHAN ELIZABETH | Agent | 1717 NORTH E STREET, PENSACOLA, FL, 32501 |
| Name | Role | Address |
|---|---|---|
| VERMILLION KERRY W | Manager | 1717 NORTH E STREET, STE. 320, PENSACOLA, FL, 32501 |
| SKOLROOD KENT | Manager | 1717 NORTH E STREET, STE. 320, PENSACOLA, FL, 32501 |
| FAULKNER MARK T | Manager | 1717 NORTH E STREET, STE. 320, PENSACOLA, FL, 32501 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G11000085372 | BAPTIST MEDICAL GROUP INTERNAL MEDICINE-GULF BREEZE | EXPIRED | 2011-08-29 | 2016-12-31 | No data | 1717 NORTH E STREET, STE. 320, PENSACOLA, FL, 32501 |
| G11000022081 | BAPTIST MEDICAL GROUP FAMILY MEDICINE-WESTSIDE | EXPIRED | 2011-03-01 | 2016-12-31 | No data | 6715 HIGHWAY 98 W, PENSACOLA, FL, 32506 |
| G11000022080 | BAPTIST MEDICAL GROUP FAMILY MEDICINE AND PEDIATRICS-SCENIC HIGHWAY | EXPIRED | 2011-03-01 | 2016-12-31 | No data | 8105 SCENIC HIGHWAY, PENSACOLA, FL, 32514 |
| G11000022083 | BAPTIST MEDICAL GROUP FAMILY MEDICINE-NAVARRE | EXPIRED | 2011-03-01 | 2016-12-31 | No data | 8990 NAVARRE PARKWAY SUITE A, NAVARRE, FL, 32566 |
| G11000022086 | BAPTIST MEDICAL GROUP FAMILY AND INTERNAL MEDICINE-NINE MILE | EXPIRED | 2011-03-01 | 2016-12-31 | No data | 9400 UNIVERSITY PARKWAY SUITE 210, PENSACOLA, FL, 32514 |
| G10000087940 | BAPTIST MEDICAL GROUP - NORTH HILL INTERNAL MEDICINE | EXPIRED | 2010-09-24 | 2015-12-31 | No data | 1717 NORTH E STREET, SUITE 320, PENSACOLA, FL, 32501 |
| G10000087935 | BAPTIST MEDICAL GROUP - RHEUMATOLOGY | EXPIRED | 2010-09-24 | 2015-12-31 | No data | 1717 NORTH E STREET, SUITE 320, PENSACOLA, FL, 32501 |
| G10000087929 | BAPTIST MEDICAL GROUP - SPECIALISTS | EXPIRED | 2010-09-24 | 2015-12-31 | No data | 1717 NORTH E STREET, SUITE 320, PENSACOLA, FL, 32501 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2013-09-27 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2012-04-26 | 1717 NORTH E STREET,, STE. 320, PENSACOLA, FL 32501 | No data |
| CHANGE OF MAILING ADDRESS | 2012-04-26 | 1717 NORTH E STREET,, STE. 320, PENSACOLA, FL 32501 | No data |
| REGISTERED AGENT NAME CHANGED | 2012-04-26 | CALLAHAN, ELIZABETH | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2012-04-26 | 1717 NORTH E STREET, STE. 320, PENSACOLA, FL 32501 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2012-04-26 |
| ANNUAL REPORT | 2011-04-12 |
| ANNUAL REPORT | 2010-08-04 |
| Florida Limited Liability | 2009-05-27 |
Date of last update: 01 Jan 2025
Sources: Florida Department of State
