| Entity Name: | PEDIATRIC PRIMARY CARE FOUNDATION, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Not For Profit Corporation |
| Status: | Active |
| Date Filed: | 18 Mar 1992 (33 years ago) |
| Document Number: | N47936 |
| FEI/EIN Number | 59-3113135 |
| Address: | 1515 EAST SILVER SPRINGS BLVD, SUITE 104, OCALA, FL 34470 |
| Mail Address: | 2375 C NE 25th Avenue, #107, OCALA, FL 34470-3913 |
| ZIP code: | 34470 |
| County: | Marion |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1770553018 | 2006-01-26 | 2015-02-03 | 1539 NE 22ND AVE, SUITE A, OCALA, FL, 344704761, US | 1539 NE 22ND AVE, SUITE A, OCALA, FL, 344704761, US | |||||||||||||||||||||||||||||||||||
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| Phone | +1 352-369-7800 |
| Fax | 3523692141 |
Authorized person
| Name | JEFFERY E BAXLA |
| Role | PROGRAM ADMINISTRATOR |
| Phone | 3523697835 |
Taxonomy
| Taxonomy Code | 251B00000X - Case Management Agency |
| Is Primary | Yes |
| Taxonomy Code | 251K00000X - Public Health or Welfare Agency |
| Is Primary | No |
| Taxonomy Code | 251V00000X - Voluntary or Charitable Agency |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 752161800 |
| State | FL |
| Issuer | MEDICAID |
| Number | 752161801 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Thompson, Kelly A, Esq. | Agent | 618 SE 17th Street, OCALA, FL 34471 |
| Name | Role | Address |
|---|---|---|
| LEE, JOSELYN | President | 2375c NE 25TH AVE #107, OCALA, FL 34470-3913 |
| Name | Role | Address |
|---|---|---|
| SAHA, TED, Dr. | Director | 2375c NE 25TH AVE #107, OCALA, FL 34470-3913 |
| Name | Role | Address |
|---|---|---|
| Boyce, Nancy | Treasurer | 2375c NE 25TH AVE #107, OCALA, FL 34470-3913 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2019-04-27 | 1515 EAST SILVER SPRINGS BLVD, SUITE 104, OCALA, FL 34470 | No data |
| CHANGE OF MAILING ADDRESS | 2018-03-19 | 1515 EAST SILVER SPRINGS BLVD, SUITE 104, OCALA, FL 34470 | No data |
| REGISTERED AGENT NAME CHANGED | 2016-04-26 | Thompson, Kelly A, Esq. | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2016-04-26 | 618 SE 17th Street, OCALA, FL 34471 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-05-01 |
| ANNUAL REPORT | 2023-04-22 |
| ANNUAL REPORT | 2022-03-11 |
| ANNUAL REPORT | 2021-04-30 |
| ANNUAL REPORT | 2020-03-25 |
| ANNUAL REPORT | 2019-04-27 |
| ANNUAL REPORT | 2018-03-19 |
| ANNUAL REPORT | 2017-03-20 |
| ANNUAL REPORT | 2016-04-26 |
| ANNUAL REPORT | 2015-04-22 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
