| Entity Name: | DESTIN ANESTHESIA, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 27 Aug 2021 (3 years ago) |
| Last Event: | CONVERSION |
| Event Date Filed: | 27 Aug 2021 (3 years ago) |
| Document Number: | L21000383625 |
| FEI/EIN Number | 59-3657595 |
| Address: | 1100 BELLEVUE WAY NE 8A #188, BELLEVUE, WA, 98004, US |
| Mail Address: | 1100 BELLEVUE WAY NE 8A #188, BELLEVUE, WA, 98004, US |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1891726394 | 2006-07-05 | 2024-09-06 | PO BOX 735771, DALLAS, TX, 753735771, US | 1225 AIRPORT RD, DESTIN, FL, 325412909, US | |||||||||||||||||||||||||||
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| Phone | +1 888-851-4642 |
| Fax | 8666658561 |
| Phone | +1 850-650-7606 |
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 |
Other Provider Identifiers
| Issuer | BCBS |
| Number | 34180 |
| State | FL |
| Name | Role |
|---|---|
| BLALOCK WALTERS, P.A. | Agent |
| Name | Role | Address |
|---|---|---|
| KREGER JAY | Chief Executive Officer | 1100 BELLEVUE WAY NE 8A #188, BELLEVUE, WA, 98004 |
| Name | Role | Address |
|---|---|---|
| HYSTAD SAMANTHA | Manager | 1100 BELLEVUE WAY NE 8A #188, BELLEVUE, WA, 98004 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-02-01 | 1100 BELLEVUE WAY NE 8A #188, BELLEVUE, WA 98004 | No data |
| CHANGE OF MAILING ADDRESS | 2023-02-01 | 1100 BELLEVUE WAY NE 8A #188, BELLEVUE, WA 98004 | No data |
| CONVERSION | 2021-08-27 | No data | CORPORATION WAS A CONVERSION RESULT. CONVERTING CORPORATION WAS P00000063816. CONVERSION NUMBER 900000217349 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-12 |
| ANNUAL REPORT | 2023-02-01 |
| ANNUAL REPORT | 2022-03-14 |
| Florida Limited Liability | 2021-08-27 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
