| Entity Name: | FLORIDA PANHANDLE ANESTHESIA ASSOCIATES, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 24 Oct 2019 (5 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 20 Sep 2022 (2 years ago) |
| Document Number: | L19000267501 |
| FEI/EIN Number | 84-3475603 |
| Address: | 1100 BELLEVUE WAY NE, STE 8A # 188, BELLEVUE, WA, 98004, US |
| Mail Address: | 1100 BELLEVUE WAY NE, STE 8A # 188, BELLEVUE, WA, 98004, US |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1982241360 | 2019-12-05 | 2024-09-06 | PO BOX 735006, DALLAS, TX, 753735006, US | 204B E 19TH ST, PANAMA CITY, FL, 324054707, US | |||||||||||||||||||||
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| Phone | +1 888-851-4642 |
| Fax | 8666658561 |
| Phone | +1 850-769-7599 |
Authorized person
| Name | JEFF PERRY |
| Role | MANAGER |
| Phone | 5024184700 |
Taxonomy
| Taxonomy Code | 207L00000X - Anesthesiology Physician |
| Is Primary | No |
| Taxonomy Code | 367500000X - Certified Registered Nurse Anesthetist |
| Is Primary | Yes |
| Name | Role |
|---|---|
| BLALOCK WALTERS, P.A. | Agent |
| Name | Role | Address |
|---|---|---|
| Stroud Robert SEsq. | Auth | 2 N. Tamiami Trail, Sarasota, FL, 34236 |
| Name | Role | Address |
|---|---|---|
| KREGER JAY | Chief Executive Officer | 1100 BELLEVUE WAY NE, BELLEVUE, WA, 98004 |
| Name | Role | Address |
|---|---|---|
| SAMANTHA HYSTAD | Manager | 1100 BELLEVUE WAY NE, BELLEVUE, WA, 98004 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC AMENDMENT | 2022-09-20 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-12 |
| ANNUAL REPORT | 2023-02-01 |
| LC Amendment | 2022-09-20 |
| ANNUAL REPORT | 2022-02-24 |
| ANNUAL REPORT | 2021-03-16 |
| ANNUAL REPORT | 2020-07-24 |
| Florida Limited Liability | 2019-10-24 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
