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BAPTIST SPECIALTY PHYSICIANS, INC. - Florida Company Profile

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Company Details

Entity Name: BAPTIST SPECIALTY PHYSICIANS, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Non-Profit
Status: Active
Date Filed: 03 Sep 2019 (6 years ago)
Last Event: REINSTATEMENT
Event Date Filed: 04 Jan 2021 (5 years ago)
Document Number: N19000009680
FEI/EIN Number 86-1126946
Address: 3563 PHILIPS HWY. BLDG. A, STE. 101, JACKSONVILLE, FL, 32207, US
Mail Address: 841 Prudential Drive, Suite 1802, JACKSONVILLE, FL, 32207, US
ZIP code: 32207
City: Jacksonville
County: Duval
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
Keith Tickell Director 841 Prudential Drive, Jacksonville, FL, 32207
Baity G. S Secretary 841 Prudential Drive, Jacksonville, FL, 32207
Finnegan T. S Asst 841 Prudential Drive, Jacksonville, FL, 32207
ZUINO MATTHEW A Director 841 Prudential Dr., Jacksonville, FL, 32207
BAITY G. SCOTT Esq. Agent 841 PRUDENTIAL DR., STE. 1802, JACKSONVILLE, FL, 32207
GORAK EDWARD DO Vice President 841 Prudential Drive, Jacksonville, FL, 32207
Mayo Michael A Director 841 Prudential Drive, Jacksonville, FL, 32207

National Provider Identifier

NPI Number:
1184392847
Certification Date:
2022-04-21

Authorized Person:

Name:
THABATA FORD
Role:
VICE PRESIDENT
Phone:

Taxonomy:

Selected Taxonomy:
207RA0002X - Adult Congenital Heart Disease Physician
Is Primary:
No
Selected Taxonomy:
207RC0000X - Cardiovascular Disease Physician
Is Primary:
No
Selected Taxonomy:
2080P0202X - Pediatric Cardiology Physician
Is Primary:
Yes

Contacts:

Fax:
9043915075
Fax:
9043937808

Events

Event Type Filed Date Value Description
ADMIN DISSOLUTION FOR ANNUAL REPORT 2022-09-23 - -
CHANGE OF MAILING ADDRESS 2021-06-08 3563 PHILIPS HWY. BLDG. A, STE. 101, JACKSONVILLE, FL 32207 -
REINSTATEMENT 2021-01-04 - -
REGISTERED AGENT NAME CHANGED 2021-01-04 BAITY, G. SCOTT, Esq. -
ADMIN DISSOLUTION FOR ANNUAL REPORT 2020-09-25 - -
CONVERSION 2019-09-03 - CORPORATION WAS A CONVERSION RESULT. CONVERTING CORPORATION WAS P05000008746. CONVERSION NUMBER 100000196151

Documents

Name Date
ANNUAL REPORT 2024-04-08
AMENDED ANNUAL REPORT 2023-09-13
ANNUAL REPORT 2023-04-05
ANNUAL REPORT 2022-04-29
AMENDED ANNUAL REPORT 2021-06-08
REINSTATEMENT 2021-01-04
Domestic Non-Profit 2019-09-03

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Date of last update: 01 Aug 2025

Sources: Florida Department of State