| Entity Name: | SOUTHERN VASCULAR OF PANAMA CITY PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 20 Aug 2013 (11 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 09 Jun 2015 (10 years ago) |
| Document Number: | L13000117504 |
| FEI/EIN Number | 46-3463844 |
| Address: | 1399 Jenks Ave, Lot 12/J, PANAMA CITY, FL, 32401, US |
| Mail Address: | 1399 Jenks Ave., Lot 12/j, PANAMA CITY, FL, 32401, US |
| ZIP code: | 32401 |
| County: | Bay |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1699109181 | 2013-09-03 | 2019-09-16 | 1399 JENKS AVE # 12, PANAMA CITY, FL, 324012442, US | 1399 JENKS AVE # 12, PANAMA CITY, FL, 324012442, US | |||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||
| Phone | +1 850-532-6303 |
| Fax | 8503075402 |
Authorized person
| Name | ASHISH K GUPTA |
| Role | PHYSICIAN/OWNER |
| Phone | 8508961696 |
Taxonomy
| Taxonomy Code | 2086S0129X - Vascular Surgery Physician |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | FLORIDA BLUE |
| Number | 004XT |
| State | FL |
| Issuer | RAILROAD MEDICARE |
| Number | DU2333 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| GUPTA WENDY K | Agent | 1811 WEAKFISH WAY, PANAMA CITY BEACH, FL, 32411 |
| Name | Role | Address |
|---|---|---|
| GUPTA ASHISH K | Managing Member | 1399 Jenks Ave, PANAMA CITY, FL, 32401 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2020-06-27 | 1399 Jenks Ave, Lot 12/J, PANAMA CITY, FL 32401 | No data |
| CHANGE OF MAILING ADDRESS | 2020-06-27 | 1399 Jenks Ave, Lot 12/J, PANAMA CITY, FL 32401 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2017-02-26 | 1811 WEAKFISH WAY, p.o box 27264, PANAMA CITY BEACH, FL 32411 | No data |
| REINSTATEMENT | 2015-06-09 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2015-06-09 | GUPTA, WENDY K | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2014-09-26 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-04 |
| ANNUAL REPORT | 2023-01-23 |
| ANNUAL REPORT | 2022-07-29 |
| ANNUAL REPORT | 2021-04-29 |
| ANNUAL REPORT | 2020-06-27 |
| ANNUAL REPORT | 2019-06-19 |
| ANNUAL REPORT | 2018-04-22 |
| ANNUAL REPORT | 2017-02-26 |
| ANNUAL REPORT | 2016-04-01 |
| REINSTATEMENT | 2015-06-09 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
