| Entity Name: | DESTIN PULMONARY CRITICAL CARE, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 31 Oct 2014 (10 years ago) |
| Document Number: | L14000170335 |
| FEI/EIN Number | 47-2352907 |
| Address: | 249 Mack Bayou Loop, Santa Rosa Beach, FL, 32459, US |
| Mail Address: | 249 Mack Bayou Loop, Santa Rosa Beach, FL, 32459, US |
| ZIP code: | 32459 |
| County: | Walton |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1801294962 | 2014-12-05 | 2018-09-12 | 249 MACK BAYOU LOOP STE 201, SANTA ROSA BEACH, FL, 324597197, US | 249 MACK BAYOU LOOP STE 201, SANTA ROSA BEACH, FL, 324597197, US | |||||||||||||||||||||||||
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| Phone | +1 850-608-6288 |
| Fax | 8506086236 |
Authorized person
| Name | MRS. PANDRA MAE YERBY |
| Role | BILLING SUPERVISOR |
| Phone | 8506086288 |
Taxonomy
| Taxonomy Code | 207RC0200X - Critical Care Medicine (Internal Medicine) Physician |
| Is Primary | Yes |
| Taxonomy Code | 207RP1001X - Pulmonary Disease Physician |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 014076700 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| PHILLIPS DAVID EM.D. | Agent | 249 Mack Bayou Loop, Santa Rosa Beach, FL, 32459 |
| Name | Role | Address |
|---|---|---|
| PHILLIPS DAVID EM.D. | Manager | 249 Mack Bayou Loop, Santa Rosa Beach, FL, 32459 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2015-04-08 | 249 Mack Bayou Loop, Suite 201, Santa Rosa Beach, FL 32459 | No data |
| CHANGE OF MAILING ADDRESS | 2015-04-08 | 249 Mack Bayou Loop, Suite 201, Santa Rosa Beach, FL 32459 | No data |
| REGISTERED AGENT NAME CHANGED | 2015-04-08 | PHILLIPS, DAVID E, M.D. | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2015-04-08 | 249 Mack Bayou Loop, Suite 201, Santa Rosa Beach, FL 32459 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-27 |
| ANNUAL REPORT | 2023-02-28 |
| ANNUAL REPORT | 2022-02-08 |
| ANNUAL REPORT | 2021-02-24 |
| ANNUAL REPORT | 2020-02-03 |
| ANNUAL REPORT | 2019-02-19 |
| ANNUAL REPORT | 2018-02-06 |
| ANNUAL REPORT | 2017-03-01 |
| ANNUAL REPORT | 2016-03-15 |
| ANNUAL REPORT | 2015-04-08 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
