| Entity Name: | NW FLORIDA EMERGENCY PHYSICIANS, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 04 Jan 2010 (15 years ago) |
| Document Number: | L10000000467 |
| FEI/EIN Number | 271578338 |
| Mail Address: | ATTN: ENTITY MANAGEMENT, 200 Corporate Blvd, Lafayette, LA, 70508, US |
| Address: | 200 Corporate Blvd, Lafayette, LA, 70508, US |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1366773566 | 2010-01-28 | 2010-05-10 | PO BOX 534600, ATLANTA, GA, 303534600, US | 6002 BERRYHILL RD, MILTON, FL, 325705062, US | |||||||||||||||||||||||||||||||||||
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| Phone | +1 800-514-1494 |
| Fax | 9048051312 |
| Phone | +1 850-626-7762 |
Authorized person
| Name | MRS. SARAH C.H. CRASS |
| Role | VICE PRESIDENT |
| Phone | 9048051300 |
Taxonomy
| Taxonomy Code | 207P00000X - Emergency Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS |
| Number | 000LT |
| State | FL |
| Issuer | RAILROAD MEDICARE |
| Number | DQ0330 |
| State | FL |
| Issuer | MEDICAID |
| Number | 116975 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| CT CORPORATION SYSTEM | Agent | 1200 SOUTH PINE ISLAND ROAD, PLANTATION, FL, 33324 |
| Name | Role |
|---|---|
| STERLING GROUP PHYSICIAN SERVICES, LLC | Manager |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2017-01-24 | 1200 SOUTH PINE ISLAND ROAD, PLANTATION, FL 33324 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2016-04-05 | 200 Corporate Blvd, Lafayette, LA 70508 | No data |
| CHANGE OF MAILING ADDRESS | 2016-04-05 | 200 Corporate Blvd, Lafayette, LA 70508 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-08 |
| ANNUAL REPORT | 2023-03-15 |
| ANNUAL REPORT | 2022-03-17 |
| ANNUAL REPORT | 2021-01-29 |
| ANNUAL REPORT | 2020-02-12 |
| ANNUAL REPORT | 2019-04-12 |
| ANNUAL REPORT | 2018-03-05 |
| ANNUAL REPORT | 2017-03-24 |
| ANNUAL REPORT | 2016-04-05 |
| ANNUAL REPORT | 2015-04-23 |
Date of last update: 02 Jan 2025
Sources: Florida Department of State
