| Entity Name: | MANATEE SPECIALTY PHYSICIAN ALLIANCE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 21 Nov 2022 (2 years ago) |
| Document Number: | L22000496854 |
| FEI/EIN Number | 92-1174273 |
| Address: | 206 SECOND STREET EAST, BRADENTON, FL, 34208, US |
| Mail Address: | 367 S GULPH RD, KING OF PRUSSIA, PA, 19406, US |
| ZIP code: | 34208 |
| County: | Manatee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1881304624 | 2022-12-02 | 2023-10-30 | 367 S GULPH RD, KING OF PRUSSIA, PA, 194063121, US | 714 MANATEE AVE E, BRADENTON, FL, 342081235, US | |||||||||||||||||||||||||||||||
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| Phone | +1 484-913-7527 |
| Phone | +1 941-212-2010 |
Authorized person
| Name | TODD EVANS |
| Role | VP - PHYS. OPERATIONS |
| Phone | 6103824422 |
Taxonomy
| Taxonomy Code | 207V00000X - Obstetrics & Gynecology Physician |
| Is Primary | No |
| Taxonomy Code | 207VX0201X - Gynecologic Oncology Physician |
| Is Primary | No |
| Taxonomy Code | 207X00000X - Orthopaedic Surgery Physician |
| Is Primary | Yes |
| Taxonomy Code | 2084N0400X - Neurology Physician |
| Is Primary | No |
| Taxonomy Code | 208600000X - Surgery Physician |
| Is Primary | No |
| Name | Role |
|---|---|
| CORPORATION SERVICE COMPANY | Agent |
| Name | Role |
|---|---|
| MANATEE PHYSICIAN ALLIANCE, LLC | Authorized Member |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-29 |
| ANNUAL REPORT | 2023-04-07 |
| Florida Limited Liability | 2022-11-21 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
