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MANATEE SPECIALTY PHYSICIAN ALLIANCE, LLC

Company Details

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

National Provider Identifier

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

Contacts

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

Agent

Name Role
CORPORATION SERVICE COMPANY Agent

Authorized Member

Name Role
MANATEE PHYSICIAN ALLIANCE, LLC Authorized Member

Documents

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