| Entity Name: | LIVE OAK NEUROSURGICAL ASSOCIATES, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 25 May 2017 (8 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 30 Sep 2021 (3 years ago) |
| Document Number: | L17000115580 |
| FEI/EIN Number | 82-1672799 |
| Address: | 1555 N Palafox St, PENSACOLA, FL, 32501, US |
| Mail Address: | 1555 N Palafox St, PENSACOLA, FL, 32501, US |
| ZIP code: | 32501 |
| County: | Escambia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1184140683 | 2017-08-16 | 2018-10-31 | PO BOX 2243, PENSACOLA, FL, 325132243, US | 8333 N DAVIS HWY FL 10, PENSACOLA, FL, 32514, US | |||||||||||||||||||||||||||||||
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| Phone | +1 850-478-1312 |
| Fax | 8504749060 |
| Phone | +1 850-512-3482 |
| Fax | 8509692130 |
Authorized person
| Name | CHARLES L WOLFF |
| Role | OWNER |
| Phone | 8508907706 |
Taxonomy
| Taxonomy Code | 207T00000X - Neurological Surgery Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 022217200 |
| State | FL |
| Issuer | FLORIDA BLUE |
| Number | QYYRS |
| State | FL |
| Name | Role | Address |
|---|---|---|
| WOLFF CHARLES M.D. | Agent | 7461 Klondike Road, PENSACOLA, FL, 32526 |
| Name | Role | Address |
|---|---|---|
| WOLFF CHARLES M.D. | Manager | 7461 Klondike Road, PENSACOLA, FL, 32526 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-10-22 | 1555 N Palafox St, PENSACOLA, FL 32501 | No data |
| CHANGE OF MAILING ADDRESS | 2024-10-22 | 1555 N Palafox St, PENSACOLA, FL 32501 | No data |
| REINSTATEMENT | 2021-09-30 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2021-09-24 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2019-10-22 | 7461 Klondike Road, PENSACOLA, FL 32526 | No data |
| REINSTATEMENT | 2019-10-22 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2019-10-22 | WOLFF, CHARLES, M.D. | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2019-09-27 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-01 |
| ANNUAL REPORT | 2023-01-23 |
| ANNUAL REPORT | 2022-01-31 |
| REINSTATEMENT | 2021-09-30 |
| ANNUAL REPORT | 2020-06-29 |
| REINSTATEMENT | 2019-10-22 |
| ANNUAL REPORT | 2018-03-17 |
| Florida Limited Liability | 2017-05-25 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
