| Entity Name: | FLORIDA MEDICAL PRACTICE PLAN, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Non-Profit |
| Status: | Active |
| Date Filed: | 20 Apr 2006 (19 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 28 Apr 2011 (14 years ago) |
| Document Number: | N06000004354 |
| FEI/EIN Number | 571234883 |
| Address: | FLORIDA STATE UNIV COLLEGE OF MEDICINE, 1115 WEST CALL STREET, TALLAHASSEE, FL, 32306-4300 |
| Mail Address: | FLORIDA STATE UNIV COLLEGE OF MEDICINE, 1115 WEST CALL STREET, TALLAHASSEE, FL, 32306-4300 |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1528631454 | 2021-07-19 | 2021-07-19 | 2911 ROBERTS AVE, TALLAHASSEE, FL, 323105007, US | 4449 MEANDERING WAY, TALLAHASSEE, FL, 323085740, US | |||||||||||||||||||
|
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| Phone | +1 850-644-1543 |
Authorized person
| Name | JULIE HUBBARD |
| Role | BILLING MANAGER |
| Phone | 8506441543 |
Taxonomy
| Taxonomy Code | 208D00000X - General Practice Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 276305202 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Littles Alma BDr. | Agent | FLORIDA STATE UNIV COLLEGE OF MEDICINE, TALLAHASSEE, FL, 323064300 |
| Name | Role | Address |
|---|---|---|
| Littles Alma BDr. | President | 1115 WEST CALL STREET, TALLAHASSEE, FL, 323064300 |
| Name | Role | Address |
|---|---|---|
| LITTLES ALMA BDr. | Secretary | 1115 WEST CALL STREET, TALLAHASSEE, FL, 323064300 |
| Name | Role | Address |
|---|---|---|
| KATZ PAUL M | Director | 1115 WEST CALL STREET, TALLAHASSEE, FL, 323064300 |
| CLARK KYLE Dr. | Director | FLORIDA STATE UNIV COLLEGE OF MEDICINE, TALLAHASSEE, FL, 323064300 |
| FLYNN HEATHER PhD | Director | FLORIDA STATE UNIV COLLEGE OF MEDICINE, TALLAHASSEE, FL, 323064300 |
| Name | Role | Address |
|---|---|---|
| NOWAKOWSKI RICHARD BPhd | Treasurer | FLORIDA STATE UNIV COLLEGE OF MEDICINE, TALLAHASSEE, FL, 323064300 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G25000002372 | FSU HEALTH LIPIDOLOGY | ACTIVE | 2025-01-06 | 2030-12-31 | No data | 1115 W. CALL STREET, TALLAHASSEE, FL, 32306 |
| G23000152580 | FSU BEHAVIORALHEALTH | ACTIVE | 2023-12-15 | 2028-12-31 | No data | 1115 W. CALL STREET, TALLAHASSEE, FL, 32306 |
| G22000070490 | FSU NEUROMODULATION | ACTIVE | 2022-06-09 | 2027-12-31 | No data | 1115 WEST CALL STREET, TALLAHASSEE, FL, 32306 |
| G18000047461 | FSU SENIORHEALTH | ACTIVE | 2018-04-13 | 2028-12-31 | No data | 1115 WEST CALL ST, TALLAHASSEE, FL, 32306 |
| G18000047464 | FSU TELEHEALTH | ACTIVE | 2018-04-13 | 2028-12-31 | No data | 1115 WEST CALL ST, TALLAHASSEE, FL, 32306 |
| G18000047469 | FSU PRIMARYHEALTH | ACTIVE | 2018-04-13 | 2028-12-31 | No data | 1115 WEST CALL ST, TALLAHASSEE, FL, 32306 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2023-03-09 | Littles, Alma B, Dr. | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2017-03-23 | FLORIDA STATE UNIV COLLEGE OF MEDICINE, 1115 WEST CALL STREET, TALLAHASSEE, FL 32306-4300 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2012-04-18 | FLORIDA STATE UNIV COLLEGE OF MEDICINE, 1115 WEST CALL STREET, TALLAHASSEE, FL 32306-4300 | No data |
| CHANGE OF MAILING ADDRESS | 2012-04-18 | FLORIDA STATE UNIV COLLEGE OF MEDICINE, 1115 WEST CALL STREET, TALLAHASSEE, FL 32306-4300 | No data |
| AMENDMENT | 2011-04-28 | No data | No data |
| AMENDMENT | 2007-07-03 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-02 |
| ANNUAL REPORT | 2023-03-09 |
| ANNUAL REPORT | 2022-04-14 |
| ANNUAL REPORT | 2021-03-30 |
| ANNUAL REPORT | 2020-03-19 |
| ANNUAL REPORT | 2019-03-29 |
| ANNUAL REPORT | 2018-04-24 |
| ANNUAL REPORT | 2017-03-23 |
| ANNUAL REPORT | 2016-03-02 |
| ANNUAL REPORT | 2015-03-20 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
