| Entity Name: | MANAGED ACCESS TO CHILD HEALTH, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Not For Profit Corporation |
| Status: | Active |
| Date Filed: | 21 Jul 1993 (32 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 15 Sep 2004 (20 years ago) |
| Document Number: | N93000003297 |
| FEI/EIN Number | 59-3192240 |
| Address: | 225 Water Street, Suite 1290, JACKSONVILLE, FL 32202 |
| Mail Address: | 225 Water Street, Suite 1290, JACKSONVILLE, FL 32202 |
| ZIP code: | 32202 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1538129002 | 2006-03-27 | 2020-08-22 | 910 N JEFFERSON ST, JACKSONVILLE, FL, 322096810, US | 910 N JEFFERSON ST, JACKSONVILLE, FL, 322096810, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 904-360-7070 |
| Fax | 9047984559 |
Authorized person
| Name | MRS. JANE C VENIARD |
| Role | PROGRAM ADMINISTRATOR |
| Phone | 9043607070 |
Taxonomy
| Taxonomy Code | 122300000X - Dentist |
| Is Primary | No |
| Taxonomy Code | 231H00000X - Audiologist |
| Is Primary | No |
| Taxonomy Code | 251B00000X - Case Management Agency |
| Is Primary | No |
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 8863585700 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Waytowich, Vicki, Ed.D. | Agent | 910 NORTH JEFFERSON ST, JACKSONVILLE, FL 32209-6810 |
| Name | Role | Address |
|---|---|---|
| CHEEK, JAMES M.D. | Director | CARITHERS PEDIATRICS, 2121 PARK ST JACKSONVILLE, FL 32204 |
| Sandler, Eric MD | Director | 807 CHILDREN'S WAY, JACKSONVILLE, FL 32207 |
| SCHIEBLER, GEROLD LMD | Director | OMNI AMELIA ISLAND PLANTATION, 408 BEACHSIDE PLACE AMELIA ISLAND, FL 32034 |
| Jaros, Allegra | Director | WOLFSON CHILDREN'S HOSPITAL, 800 PRUDENTIAL DR JACKSONVILLE, FL 32207 |
| Toney, Mark, M.D. | Director | WOLFSON CHILDREN'S HOSPITAL, 800 PRUDENTIAL DR SUITE 208 JACKSONVILLE, FL 32207 |
| TICE, KELLI, M.D. | Director | 900 UNIVERSITY BLVD N, MC-33 JACKSONVILLE, FL 32211 |
| ERHARD, MICHAEL, M.D. | Director | NEMOURS CHILDREN'S CLINIC, 807 CHILDREN'S WAY JACKSONVILLE, FL 32207 |
| HUDAK, MARK, M.D. | Director | UF COLLEGE OF MEDICINE-JACKSONVILLE, 653-1 WEST 8TH ST, LRC 3 JACKSONVILLE, FL 32209 |
| THOMPSON, SHELLY, M.D. | Director | CENTER FOR WOMEN AND CHILDREN, 515 W 6TH ST. MC-51 JACKSONVILLE, FL 32206 |
| Cuffe, Steven, MD | Director | UF Health, 580 West 8th Street Jacksonville, FL 32209 |
| Name | Role | Address |
|---|---|---|
| Kellogg, Julie, M.D. | Vice Chairman | 2627 Riverside Ave., JACKSONVILLE, FL 32204 |
| Name | Role | Address |
|---|---|---|
| Atkins, Bethany, MD | Chairman | Baptist Pediatrics, 3945 San Jose Park Dr Jacksonville, FL 32217 |
| Name | Role | Address |
|---|---|---|
| Rolle, Pauline, M.D. | Treasurer | 1 Shirlciff Way, Jacksonville, FL 32205 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G20000001402 | PARTNERSHIP FOR CHILD HEALTH | ACTIVE | 2020-01-04 | 2025-12-31 | No data | 910 NORTH JEFFERSON STREET, JACKSONVILLE, FL, 32209 |
| G08035900314 | PARTNERSHIP FOR CHILD HEALTH | EXPIRED | 2008-02-04 | 2013-12-31 | No data | 910 NORTH JEFFERSON STREET, JACKSONVILLE, FL, 32209 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-07-31 | 225 Water Street, Suite 1290, JACKSONVILLE, FL 32202 | No data |
| CHANGE OF MAILING ADDRESS | 2024-07-31 | 225 Water Street, Suite 1290, JACKSONVILLE, FL 32202 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-02-17 | 910 NORTH JEFFERSON ST, JACKSONVILLE, FL 32209-6810 | No data |
| REGISTERED AGENT NAME CHANGED | 2018-03-28 | Waytowich, Vicki, Ed.D. | No data |
| AMENDMENT | 2004-09-15 | No data | No data |
| AMENDMENT | 1994-03-14 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-18 |
| ANNUAL REPORT | 2023-03-10 |
| ANNUAL REPORT | 2022-03-09 |
| ANNUAL REPORT | 2021-02-17 |
| ANNUAL REPORT | 2020-04-28 |
| ANNUAL REPORT | 2019-04-08 |
| ANNUAL REPORT | 2018-03-28 |
| ANNUAL REPORT | 2017-02-14 |
| ANNUAL REPORT | 2016-01-27 |
| ANNUAL REPORT | 2015-05-04 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
