| Entity Name: | WEST FLORIDA RADIOLOGY ASSOCIATES, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 26 Jan 1990 (35 years ago) |
| Document Number: | L46627 |
| FEI/EIN Number | 59-2985048 |
| Mail Address: | 6478 HIGHWAY 90, SUITE D, MILTON, FL 32570 |
| Address: | 6002 BERRYHILL RD, MILTON, FL 32570 |
| ZIP code: | 32570 |
| County: | Santa Rosa |
| Place of Formation: | FLORIDA |
| Type | Company Name | Company Number | State |
|---|---|---|---|
| Headquarter of | WEST FLORIDA RADIOLOGY ASSOCIATES, P.A., COLORADO | 20181653142 | COLORADO |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1396724654 | 2006-01-13 | 2015-02-09 | 6478 HIGHWAY 90, SUITE D, MILTON, FL, 325704560, US | 6002 BERRYHILL RD, MILTON, FL, 325705062, US | |||||||||||||||||||||||
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| Phone | +1 850-564-1030 |
| Fax | 8505641039 |
| Phone | +1 850-626-7762 |
Authorized person
| Name | PATRICIA S. HAMBLEY |
| Role | PRESIDENT |
| Phone | 8505641030 |
Taxonomy
| Taxonomy Code | 2085R0202X - Diagnostic Radiology Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 054828600 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| ROSS, DAVID M., MD | Agent | 6002 BERRYHILL RD, MILTON, FL 32570 |
| Name | Role | Address |
|---|---|---|
| MARTI, JON K, DO | Director | 6478 HIGHWAY 90 STE D, MILTON, FL 32570 |
| Name | Role | Address |
|---|---|---|
| PEVSNER, DEBORAH L, MD | Secretary | 6478 HIGHWAY 90 STE D, MILTON, FL 32570 |
| Name | Role | Address |
|---|---|---|
| NATHAN D CECAVA, MD | Treasurer | 6478 HIGHWAY 90, SUITE D MILTON, FL 32570 |
| Name | Role | Address |
|---|---|---|
| ROSS, DAVID M, MD | President | 6478 HIGHWAY 90 STE D, MILTON, FL 32570 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2021-02-19 | ROSS, DAVID M., MD | No data |
| CHANGE OF MAILING ADDRESS | 2006-03-15 | 6002 BERRYHILL RD, MILTON, FL 32570 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2003-03-19 | 6002 BERRYHILL RD, MILTON, FL 32570 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2003-03-19 | 6002 BERRYHILL RD, MILTON, FL 32570 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-19 |
| AMENDED ANNUAL REPORT | 2023-07-05 |
| ANNUAL REPORT | 2023-04-05 |
| ANNUAL REPORT | 2022-04-14 |
| AMENDED ANNUAL REPORT | 2021-07-12 |
| ANNUAL REPORT | 2021-02-19 |
| AMENDED ANNUAL REPORT | 2020-08-25 |
| ANNUAL REPORT | 2020-04-02 |
| AMENDED ANNUAL REPORT | 2019-06-14 |
| ANNUAL REPORT | 2019-04-04 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
